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Debridement Technique for Single-Stage Revision Shoulder Arthroplasty.
JBJS Essent Surg Tech
January 2025
Shoulder and Elbow Service, Florida Orthopaedic Institute, Tampa, Florida.
Background: The incidence of revision shoulder arthroplasty continues to rise, and infection is a common indication for revision surgery. Treatment of periprosthetic joint infection (PJI) in the shoulder remains a controversial topic, with the literature reporting varying methodologies, including the use of debridement and implant retention, single-stage and 2-stage surgeries, antibiotic spacers, and resection arthroplasty. Single-stage revision has been shown to have a low rate of recurrent infection, making it more favorable because it precludes the morbidity of a 2-stage operation.
View Article and Find Full Text PDFModular dual-mobility constructs outperformed large femoral heads in 299 revision total hip arthroplasties at mid-term follow-up.
Bone Joint J
January 2025
Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
Article Synopsis
- The study aimed to compare the Modular Dual Mobility (MDM) hip system and large femoral heads (LFHs) in revision total hip arthroplasties (THAs), focusing on risks like dislocation and metal-related complications.
- Researchers analyzed 299 revision THAs and found that the MDM group had a significantly lower rate of re-revision for dislocation (99% survival) compared to the LFH group (91% survival), with increased risks for LFH patients.
- Overall, THAs utilizing the MDM construct demonstrated a safer profile, particularly in reducing re-revisions related to dislocation and had no reported issues with metallosis or corrosion.
Identifying potential predictive indicators for reimplantation timing in two-stage revision: a meta-analysis and system review.
Arch Orthop Trauma Surg
December 2024
Department of Orthopedic Surgery and Orthopedic Research Institute, Stem Cell and Tissue Engineering Research Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China.
Purpose: The two-stage exchange revision represents a pivotal strategy in the management of prosthetic joint infections, wherein the judicious timing of reimplantation serves as a crucial determinant for therapeutic success. At present, attempts have been made to utilize predictive models to establish the optimal timing for reimplantation; however, their predictive accuracy remains unsatisfactory. This inadequacy primarily arises from the lack of dependable predictive indicators, which demonstrate inconsistent effectiveness across various studies and occasionally yield contradictory outcomes.
View Article and Find Full Text PDFSpacers in two-stage strategy for periprosthetic infection.
Orthop Traumatol Surg Res
November 2024
Service de Chirurgie Orthopédique et Médecine du Sport, Centre d'Excellence FIFA, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France; Univ Lyon, Université Claude Bernard Lyon 1, IFSTTAR, LBMC UMR_T9406, 69622 Villeurbanne, France.
In two-stage revision of infected implants, the first stage involves removing the implant and implanting a joint spacer, and the second stage involves implanting a new prosthesis at least 6 weeks later. Spacers have two main functions: local administration of high-dose antibiotics, and preservation of the joint space by reducing soft tissue retraction and improving patient comfort until reimplantation. The present review aims to detail the necessary characteristics of antibiotics added to cement to achieve good joint diffusion, to describe the steps of two-stage revision, and to present the types of spacer available according to the joint and complications.
View Article and Find Full Text PDFAtypical Periprosthetic Joint Infection Post-Total Knee Arthroplasty: A Case of Actinomyces europaeus.
Cureus
October 2024
Orthopedics and Traumatology Department, University Emergency Hospital Bucharest, Bucharest, ROU.
Periprosthetic joint infection (PJI) is a significant complication following total knee arthroplasty (TKA), representing a substantial challenge due to the difficulty in diagnosis and management. The main causes are predominantly common bacteria, but rare pathogens such as can complicate diagnosis and treatment. We report a unique case of a 75-year-old Caucasian patient with a history of multiple comorbidities including obesity, arterial hypertension, total thyroidectomy, rheumatoid arthritis, and prior venous thrombosis.
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