Current Concepts on the Clinical and Economic Impact of Periprosthetic Joint Infections
Orthop Clin North Am. 2024 Apr;55(2):151-159. doi: 10.1016/j.ocl.2023.09.001. Epub 2023 Oct 17.ABSTRACTTotal joint arthroplasty (TJA) is a common procedure performed throughout the entire world in hopes of alleviating debilitating hip or knee pain. The projected number of TJAs performed in the United States alone is projected to exceed 1.9 million by 2030 and 5 million by 2040. With the significant increase in TJA performed, more periprosthetic joint infections (PJIs) are likely to be encountered. PJIs are a devastating complication of TJA. The economic and clinical burden must be understood and respected to minimize occur...
Source: The Orthopedic Clinics of North America - February 25, 2024 Category: Orthopaedics Authors: Shaan Sadhwani Anthony Kamson Andrew J Frear Nadine Sadaka Kenneth L Urish Source Type: research

Biofilm and How It Relates to Prosthetic Joint Infection
Orthop Clin North Am. 2024 Apr;55(2):161-169. doi: 10.1016/j.ocl.2023.10.001. Epub 2023 Oct 29.ABSTRACTProsthetic joint infection following total joint arthroplasty is a devastating complication, resulting in increased morbidity and mortality for the patient. The formation of a biofilm on implanted hardware contributes to the difficulty in successful identification and eradication of the infection. Antibiotic therapy and surgical intervention are necessary for addressing this condition; we present a discussion on different treatment options, including those that are not yet routinely utilized in the clinical setting or are...
Source: The Orthopedic Clinics of North America - February 25, 2024 Category: Orthopaedics Authors: Ashley E MacConnell Ashley E Levack Nicholas M Brown Source Type: research

Innovations in the Isolation and Treatment of Biofilms in Periprosthetic Joint Infection: A Comprehensive Review of Current and Emerging Therapies in Bone and Joint Infection Management
This article focuses on the identification of biofilms, as well as current methodologies and emerging therapies in the management of biofilms in PJI.PMID:38403364 | DOI:10.1016/j.ocl.2023.10.002 (Source: The Orthopedic Clinics of North America)
Source: The Orthopedic Clinics of North America - February 25, 2024 Category: Orthopaedics Authors: Spencer A Ward Akram A Habibi Itay Ashkenazi Armin Arshi Morteza Meftah Ran Schwarzkopf Source Type: research

Articulating Spacers in Total Hip Arthroplasty: Surgical Technique and Outcomes
Orthop Clin North Am. 2024 Apr;55(2):181-192. doi: 10.1016/j.ocl.2023.06.002. Epub 2023 Aug 1.ABSTRACTAlthough one-stage exchange arthroplasty is gaining popularity, two-stage exchange arthroplasty remains the gold standard for the treatment of periprosthetic joint infections. Use of an articulating spacer for this procedure offers an avenue for maintaining hip motion and controlled weight-bearing, allowing local antibiotic elution. However, there is no uniform consensus on the optimal surgical protocol for using articulating spacers. This review describes the surgical technique for undertaking a first-stage exchange arthr...
Source: The Orthopedic Clinics of North America - February 25, 2024 Category: Orthopaedics Authors: Babar Kayani Francisco Bengoa Lisa C Howard Michael E Neufeld Bassam A Masri Source Type: research

Recurrent Periprosthetic Joint Infections: Diagnosis, Management, and Outcomes
Orthop Clin North Am. 2024 Apr;55(2):193-206. doi: 10.1016/j.ocl.2023.09.002. Epub 2023 Oct 10.ABSTRACTPeriprosthetic joint infection (PJI) remains one of the most common complications after total joint arthroplasty. It is challenging to manage, associated with significant morbidity and mortality, and is a financial burden on the health care system. Failure of 2-stage management for chronic PJI is not uncommon. Repeat infections are oftentimes polymicrobial, multiple drug-resistant microorganisms, or new organisms. Optimizing the success of index 2-stage revision is the greatest prevention against failure of any subsequent...
Source: The Orthopedic Clinics of North America - February 25, 2024 Category: Orthopaedics Authors: Christopher F Deans Beau J Kildow Kevin L Garvin Source Type: research

The State of Local Antibiotic Use in Orthopedic Trauma
Orthop Clin North Am. 2024 Apr;55(2):207-216. doi: 10.1016/j.ocl.2023.07.003. Epub 2023 Aug 21.ABSTRACTFracture-related infections are a challenging complication in orthopedic trauma that often necessitates multiple surgeries. Early administration of systemic antibiotics and surgical intervention remains the gold standard of care, but despite these measures, treatment failures can be as high as 35%. For these reasons, the introduction of local antibiotics at the site of at-risk fractures has increased over the past decade. This review looks at the various measures being used clinically including local antibiotic powder, po...
Source: The Orthopedic Clinics of North America - February 25, 2024 Category: Orthopaedics Authors: Carlo Eikani Aaron Hoyt Elizabeth Cho Ashley E Levack Source Type: research

Navigating the Enigma of Pediatric Musculoskeletal Infections: A Race Against Time
Orthop Clin North Am. 2024 Apr;55(2):217-232. doi: 10.1016/j.ocl.2023.09.004. Epub 2023 Oct 20.ABSTRACTMusculoskeletal infection (MSKI) in children is a critical condition in pediatric orthopedics due to the potential for serious adverse outcomes, including multiorgan dysfunction syndrome, which can lead to death. The diagnosis and treatment of MSKI continue to evolve with advancements in infectious organisms, diagnostic technologies, and pharmacologic treatments. It is imperative for pediatric orthopedic surgeons and medical teams to remain up to date with the latest MSKI practices.PMID:38403368 | DOI:10.1016/j.ocl.2023.0...
Source: The Orthopedic Clinics of North America - February 25, 2024 Category: Orthopaedics Authors: Stephanie N Moore-Lotridge Brian Q Hou Katherine S Hajdu Malini Anand William Hefley Jonathan G Schoenecker Source Type: research

Sequestration and Involucrum: Understanding Bone Necrosis and Revascularization in Pediatric Orthopedics
Orthop Clin North Am. 2024 Apr;55(2):233-246. doi: 10.1016/j.ocl.2023.09.005. Epub 2023 Oct 17.ABSTRACTSequestration, a condition where a section of bone becomes necrotic due to a loss of vascularity or thrombosis, can be a challenging complication of osteomyelitis. This review explores the pathophysiology of sequestration, highlighting the role of the periosteum in forming involucrum and creeping substitution which facilitate revascularization and bone formation. The authors also discuss the induced membrane technique, a two-stage surgical procedure for cases of failed healing of sequestration. Future directions include t...
Source: The Orthopedic Clinics of North America - February 25, 2024 Category: Orthopaedics Authors: Katherine S Hajdu Courtney E Baker Stephanie N Moore-Lotridge Jonathan G Schoenecker Source Type: research

The Septic Elbow Joint: Treatment Approaches for Improved Patient Outcomes
Orthop Clin North Am. 2024 Apr;55(2):247-255. doi: 10.1016/j.ocl.2023.09.007. Epub 2023 Nov 8.ABSTRACTSeptic arthritis of the elbow is a serious problem requiring prompt, accurate diagnosis and urgent surgical intervention. Achieving successful patient outcomes depends heavily on early diagnosis and efficient streamlined surgical treatment. Essential tactics for treating the septic elbow joint include immediate joint irrigation and debridement in addition to administration of appropriate antibiotics. This comprehensive review delves into the cause of the septic elbow joint, identifies associated risk factors, and provides ...
Source: The Orthopedic Clinics of North America - February 25, 2024 Category: Orthopaedics Authors: Heather L Mercer Diego Rodriguez Elizabeth Mikola Deana Mercer Source Type: research

Diagnostic Evaluation of Prosthetic Joint Infections of the Shoulder: What Does the Literature Say?
Orthop Clin North Am. 2024 Apr;55(2):257-264. doi: 10.1016/j.ocl.2023.09.006. Epub 2023 Oct 20.ABSTRACTThe total number of patients with a total shoulder arthroplasty (TSA) is increasing, and the number of patients experiencing a (TSA) prosthetic joint infection (PJI) also will increase. It is important that physicians know how to identify signs of infection, know the common pathogens, and know how to work up a shoulder PJI. This publication reviewed the current literature about presenting signs and symptoms, common shoulder pathogens and how they differ from total knee and hip pathogens, and what images, tests, and proced...
Source: The Orthopedic Clinics of North America - February 25, 2024 Category: Orthopaedics Authors: Jeffrey Klott Tyler J Brolin Source Type: research

Fingertip Infections
This article reviews fingertip anatomy, common and uncommon fingertip infections and their mimics, and recommendations for management.PMID:38403372 | DOI:10.1016/j.ocl.2023.10.003 (Source: The Orthopedic Clinics of North America)
Source: The Orthopedic Clinics of North America - February 25, 2024 Category: Orthopaedics Authors: James Barger Reed W Hoyer Source Type: research

Management of the Septic Wrist: A Systematic Review of Etiology and Therapeutic Strategies
Orthop Clin North Am. 2024 Apr;55(2):273-283. doi: 10.1016/j.ocl.2023.11.002. Epub 2023 Dec 9.ABSTRACTSeptic arthritis of the wrist can have severe deleterious effects on cartilage and bone if not promptly addressed. Expedient diagnosis and early medical intervention are important. The most effective strategy involves immediate arthrocentesis of the infected joint, enabling precise antibiotic selection based on joint fluid analysis. Diagnostic imaging is important in excluding fractures and identifying abscesses. This review explores the etiologic factors underlying septic wrist joint, identifying risk factors, and delinea...
Source: The Orthopedic Clinics of North America - February 25, 2024 Category: Orthopaedics Authors: Heather L Mercer Diego Rodriguez Rhiana Rivas Elizabeth Rivenbark Elizabeth Mikola Deana Mercer Source Type: research

Diagnosis and Management of Infected Total Ankle Replacements
Orthop Clin North Am. 2024 Apr;55(2):285-297. doi: 10.1016/j.ocl.2023.08.001. Epub 2023 Sep 27.ABSTRACTAs the number of primary total ankle replacements increases for treatment of end-stage ankle arthritis, failures are also expected to rise. Periprosthetic joint infection is among the causes of failures and has been reported to be as high as 5%. Diagnosis is usually made by a combination of clinical examination findings, imaging, laboratory, and microbiological workup. Management is generally separated into limb salvage or amputation. Limb salvage can be challenging and may involve a single versus staged approach. Options...
Source: The Orthopedic Clinics of North America - February 25, 2024 Category: Orthopaedics Authors: Benjamin D Umbel Brandon A Haghverdian Karl M Schweitzer Samuel B Adams Source Type: research

The Differentiation Between Infection and Acute Charcot
Orthop Clin North Am. 2024 Apr;55(2):299-309. doi: 10.1016/j.ocl.2023.08.002. Epub 2023 Sep 7.ABSTRACTThe differentiation between acute Charcot neuroarthropathy and infection in the foot and ankle should be supported by multiple criteria. A detailed history and physical examination should always be completed. Plain radiographs should be performed, though advanced imaging, currently MRI, is more helpful in diagnosis. Scintigraphy and PET may become the standard imaging modalities once they are more clinically available due to their reported increased accuracy. Laboratory analysis can also act as a helpful diagnostic tool. H...
Source: The Orthopedic Clinics of North America - February 25, 2024 Category: Orthopaedics Authors: Ryan G Rogero Samhita Swamy Clayton C Bettin Source Type: research

Infections
Orthop Clin North Am. 2024 Apr;55(2):xv-xvi. doi: 10.1016/j.ocl.2023.12.001. Epub 2023 Dec 16.NO ABSTRACTPMID:38403376 | DOI:10.1016/j.ocl.2023.12.001 (Source: The Orthopedic Clinics of North America)
Source: The Orthopedic Clinics of North America - February 25, 2024 Category: Orthopaedics Authors: Frederick M Azar Source Type: research