Articles | Volume 6, issue 4
https://doi.org/10.5194/jbji-6-85-2021
© Author(s) 2021. This work is distributed under
the Creative Commons Attribution 4.0 License.
the Creative Commons Attribution 4.0 License.
https://doi.org/10.5194/jbji-6-85-2021
© Author(s) 2021. This work is distributed under
the Creative Commons Attribution 4.0 License.
the Creative Commons Attribution 4.0 License.
Brief report
| 
27 Jan 2021
Brief report |
| 27 Jan 2021
| 27 Jan 2021
Fluorescent tetracycline bone labeling as an intraoperative tool to debride necrotic bone during septic hip revision: a preliminary case series
Department of Orthopaedics and Trauma Surgery, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
Jenaro Ángel Fernández-Valencia
Department of Orthopaedics and Trauma Surgery, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
Andreu Combalia
Department of Orthopaedics and Trauma Surgery, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
Laura Morata
Department of Infectious Diseases, Hospital Clínic de Barcelona,
University of Barcelona, Barcelona, Spain
Álex Soriano
Department of Infectious Diseases, Hospital Clínic de Barcelona,
University of Barcelona, Barcelona, Spain
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Ernesto Muñoz-Mahamud, Eduard Tornero, José A. Estrada, Jenaro A. Fernández-Valencia, Juan C. Martínez-Pastor, and Álex Soriano
J. Bone Joint Infect., 7, 109–115, https://doi.org/10.5194/jbji-7-109-2022, https://doi.org/10.5194/jbji-7-109-2022, 2022
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A patient with normal D-dimer value has a low risk of prosthetic joint infection, so serum D-dimer assessment should always be considered as a useful test to rule out chronic prosthetic joint infection (especially in those cases caused by low-virulence microorganisms in which conventional tests may lead to misdiagnosis). Conversely, the platelet count to mean platelet volume ratio may be of limited value for accurately diagnosing prosthetic joint infection.
Irene K. Sigmund, Marjan Wouthuyzen-Bakker, Tristan Ferry, Willem-Jan Metsemakers, Martin Clauss, Alex Soriano, Rihard Trebse, and Ricardo Sousa
J. Bone Joint Infect., 10, 139–142, https://doi.org/10.5194/jbji-10-139-2025, https://doi.org/10.5194/jbji-10-139-2025, 2025
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This is a summary of our position paper on debridement, antimicrobial therapy, and implant retention (DAIR) procedures as a curative treatment strategy for acute periprosthetic hip and knee infections. It includes the defined indications as well as the contraindications of DAIR procedures when eradication/cure is intended, based on the currently available literature.
Irene K. Sigmund, Tristan Ferry, Ricardo Sousa, Alex Soriano, Willem-Jan Metsemakers, Martin Clauss, Rihard Trebse, and Marjan Wouthuyzen-Bakker
J. Bone Joint Infect., 10, 101–138, https://doi.org/10.5194/jbji-10-101-2025, https://doi.org/10.5194/jbji-10-101-2025, 2025
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In this paper, we discuss the most relevant factors influencing the outcome and define indications, contraindications, and risk factors of a DAIR procedure based on the currently available literature. Furthermore, we discuss the surgical technique in combination with systemic antimicrobial therapy in patients undergoing a DAIR procedure.
Marta Sabater-Martos, Oscar Garcia, Laia Boadas, Laura Morata, Alex Soriano, and Juan Carlos Martínez-Pastor
J. Bone Joint Infect., 10, 41–49, https://doi.org/10.5194/jbji-10-41-2025, https://doi.org/10.5194/jbji-10-41-2025, 2025
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This is a retrospective diagnostic study in acute postoperative prosthetic joint infection in total knee arthroplasty that wants to determine diagnostic accuracy of synovial glucose and serum-to-synovial glucose ratio in acute postoperative infection. Both tests demonstrated good diagnostic potential. Notably, these biomarkers exhibited superior accuracy compared to the combination of C-reactive protein, synovial white blood cell count and polymorphonuclear percentage.
Laia Boadas-Gironès, Marta Sabater-Martos, Marc Ferrer-Banus, Àlex Soriano-Viladomiu, and Juan Carlos Martínez-Pastor
J. Bone Joint Infect., 9, 241–248, https://doi.org/10.5194/jbji-9-241-2024, https://doi.org/10.5194/jbji-9-241-2024, 2024
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When acute soft tissue defects are present after knee arthroplasty, the infection risk is high. A gastrocnemius flap is used for anterior defects, and it is not usually combined with debridement surgery unless infection is clear. We examined the benefit of combining coverage treatment with debridement surgery, DAIR, comparing the isolated traditional coverage treatment. The results suggested a higher healing rate in the combined treatment, so we recommended it.
Seung-Jae Yoon, Paul C. Jutte, Alex Soriano, Ricardo Sousa, Wierd P. Zijlstra, and Marjan Wouthuyzen-Bakker
J. Bone Joint Infect., 9, 231–239, https://doi.org/10.5194/jbji-9-231-2024, https://doi.org/10.5194/jbji-9-231-2024, 2024
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This study validated three models for predicting infection after hip and knee replacement surgery. By analyzing data from 2684 patients in the Netherlands, Portugal, and Spain, we found that the models developed by Tan, Del Toro, and Bülow effectively identified high-risk patients. These models can be used to enhance preoperative counseling and to tailor infection prevention measures individually, potentially improving outcomes and reducing healthcare costs.
Marta Sabater-Martos, Marc Ferrer, Laura Morata, Alex Soriano, and Juan Carlos Martínez-Pastor
J. Bone Joint Infect., 9, 17–26, https://doi.org/10.5194/jbji-9-17-2024, https://doi.org/10.5194/jbji-9-17-2024, 2024
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This is a meta-analysis of six studies describing the cutoff values of white blood cell count and polymorphonuclear percentage in synovial fluid for the diagnosis of acute postoperative peri-prosthetic joint infection (PJI).
We found that both the WBC count and PMN percentage are good markers for diagnosis of acute postoperative PJI. However, the synovial WBC count is more powerful in diagnosing acute postoperative PJI.
We found that both the WBC count and PMN percentage are good markers for diagnosis of acute postoperative PJI. However, the synovial WBC count is more powerful in diagnosing acute postoperative PJI.
Christen Ravn, Jeroen Neyt, Natividad Benito, Miguel Araújo Abreu, Yvonne Achermann, Svetlana Bozhkova, Liselotte Coorevits, Matteo Carlo Ferrari, Karianne Wiger Gammelsrud, Ulf-Joachim Gerlach, Efthymia Giannitsioti, Martin Gottliebsen, Nis Pedersen Jørgensen, Tomislav Madjarevic, Leonard Marais, Aditya Menon, Dirk Jan Moojen, Markus Pääkkönen, Marko Pokorn, Daniel Pérez-Prieto, Nora Renz, Jesús Saavedra-Lozano, Marta Sabater-Martos, Parham Sendi, Staffan Tevell, Charles Vogely, Alex Soriano, and the SANJO guideline group
J. Bone Joint Infect., 8, 29–37, https://doi.org/10.5194/jbji-8-29-2023, https://doi.org/10.5194/jbji-8-29-2023, 2023
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Management of septic arthritis in native joints (SANJO) is often conducted by clinicians of different specialties, experience levels, and at all hours of the day. The SANJO guideline group makes evidence-based recommendations for diagnosis, microbiological investigation, initial surgery, empirical antibiotic treatment, early mobilization, evaluation of outcomes, and treatment failure. Special considerations were made for children, tuberculosis, and SANJO after cruciate ligament reconstruction.
Efthymia Giannitsioti, Mauro José Salles, Andreas Mavrogenis, Dolors Rodriguez-Pardo, Ibai Los-Arcos, Alba Ribera, Javier Ariza, María Dolores del Toro, Sophie Nguyen, Eric Senneville, Eric Bonnet, Monica Chan, Maria Bruna Pasticci, Sabine Petersdorf, Natividad Benito, Nuala O' Connell, Antonio Blanco García, Gábor Skaliczki, Pierre Tattevin, Zeliha Kocak Tufan, Nikolaos Pantazis, Panayiotis D. Megaloikonomos, Panayiotis Papagelopoulos, Alejandro Soriano, Antonios Papadopoulos, and the ESGIAI collaborators study group
J. Bone Joint Infect., 7, 279–288, https://doi.org/10.5194/jbji-7-279-2022, https://doi.org/10.5194/jbji-7-279-2022, 2022
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Our multicentre study on a lower-limb osteosynthesis-associated infection (OAI) cohort by multidrug (MDR) and extensively drug (XDR) resistant Gram-negative bacteria found the following: implant retention with debridement was mostly performed in early OAI; 50.9 % of patients achieved remission of infection; remission reached 50 % (MDR) vs. 25 % (XDR) in early OAI and 60 % (MDR) vs. 44.4 % (XDR) in late OAI; age (> 60) and multiple surgeries were independent factors influencing lack of remission.
Ernesto Muñoz-Mahamud, Eduard Tornero, José A. Estrada, Jenaro A. Fernández-Valencia, Juan C. Martínez-Pastor, and Álex Soriano
J. Bone Joint Infect., 7, 109–115, https://doi.org/10.5194/jbji-7-109-2022, https://doi.org/10.5194/jbji-7-109-2022, 2022
Short summary
Short summary
A patient with normal D-dimer value has a low risk of prosthetic joint infection, so serum D-dimer assessment should always be considered as a useful test to rule out chronic prosthetic joint infection (especially in those cases caused by low-virulence microorganisms in which conventional tests may lead to misdiagnosis). Conversely, the platelet count to mean platelet volume ratio may be of limited value for accurately diagnosing prosthetic joint infection.
Karel-Jan Dag François Lensen, Rosa Escudero-Sanchez, Javier Cobo, Rihard Trebše, Camelia Gubavu, Sara Tedeschi, Jose M. Lomas, Cedric Arvieux, Dolors Rodriguez-Pardo, Massimo Fantoni, Maria Jose Garcia Pais, Francisco Jover, Mauro José Costa Salles, Ignacio Sancho, Marta Fernandez Sampedro, Alex Soriano, Marjan Wouthuyzen-Bakker, and ESCMID Study Group of Implant Associated Infections (ESGIAI)
J. Bone Joint Infect., 6, 313–319, https://doi.org/10.5194/jbji-6-313-2021, https://doi.org/10.5194/jbji-6-313-2021, 2021
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Our data suggest that, in periprosthetic joint infection (PJI) patients with a draining sinus, suppressive antibiotic treatment (SAT) can be considered on an individual basis. SAT may reduce pain and favour the closure of the sinus tract in certain individuals, but the prescription of SAT does not appear to have any influence on the prevention of prosthetic loosening and other infectious complications.
Karel-Jan Lensen, Rosa Escudero-Sanchez, Javier Cobo, Alex Soriano, and Marjan Wouthuyzen-Bakker
J. Bone Joint Infect., 6, 43–45, https://doi.org/10.5194/jbji-6-43-2020, https://doi.org/10.5194/jbji-6-43-2020, 2020
Related subject area
Subject: Prosthesis-related infections | Topic: Surgery
One-year infection control rates of a DAIR (debridement, antibiotics and implant retention) procedure after primary and prosthetic-joint-infection-related revision arthroplasty – a retrospective cohort study
F. Ruben H. A. Nurmohamed, Bruce van Dijk, Ewout S. Veltman, Marrit Hoekstra, Rob J. Rentenaar, Harrie H. Weinans, H. Charles Vogely, and Bart C. H. van der Wal
J. Bone Joint Infect., 6, 91–97, https://doi.org/10.5194/jbji-6-91-2021, https://doi.org/10.5194/jbji-6-91-2021, 2021
Short summary
Short summary
Literature reporting on the effectiveness of DAIR (debridement, antibiotics and implant retention) procedures performed after a one- or two-stage revision because of a prosthetic joint infection (PJI-related revision arthroplasty) is scarce. Infection control rates of a DAIR procedure after primary arthroplasty (n = 51) and after prior PJI-related revision arthroplasty (n = 16) were 69 % and 56 %, respectively. No statistically significant difference is found in infection control after 1 year.
Cited articles
Bémer, P., Léger, J., Tandé, D., Plouzeau, C., Valentin, A. S.,
Jolivet-Gougeon, A., Lemarié, C., Kempf, M., Héry-Arnaud, G., Bret, L., Juvin,
M. E., Giraudeau, B., Corvec, S., and Burucoa, C.: Centre de Référence des
Infections Ostéo-articulaires du Grand Ouest (CRIOGO) Study Team:
How Many Samples and How Many Culture Media To Diagnose a Prosthetic Joint
Infection: a Clinical and Microbiological Prospective Multicenter Study, J.
Clin. Microbiol., 54, 385–391, https://doi.org/10.1128/JCM.02497-15,
2016.
Dahners, L. E. and Bos, G. D.: Fluorescent tetracycline labeling as an aid to
debridement of necrotic bone in the treatment of chronic osteomyelitis, J
Orthop. Trauma., 16, 345–346, https://doi.org/10.1097/00005131-200205000-00009, 2002.
Duwelius, P. J. and Schmidt, A. H.: Assessment of bone viability in patients with
osteomyelitis: preliminary clinical experience with laser Doppler flowmetry,
J. Orthop. Trauma., 6, 327–332, 1992.
Giudice, A., Bennardo, F., Barone, S., Antonelli, A., Figliuzzi, L. F., and Fortunato, L.:
Can autofluorescence guide surgeons in the treatment of medication-related
osteonecrosis of the jaw? A prospective feasibility study, J. Oral Maxillofac.
Surg., 76, 982–995, 2018.
Harvey, B. R., Ephros, H., and Defalco, R. J.: Tetracycline bone labeling in surgical
management of chronic osteomyelitis: a case report, J. Oral Maxillofac. Surg.,
62, 752–754, https://doi.org/10.1016/j.joms.2003.08.036, 2004.
Hoberg, M., Konrads, C., Engelien, J., Oschmann, D., Holder, M., Walcher, M., Steinert,
A., and Rudert, M.: Similar outcomes between two-stage revisions for infection and
aseptic hip revisions, Int Orthop., 40, 459–464, https://doi.org/10.1007/s00264-015-2850-3, 2016.
Jensen, L. K., Koch, J., Henriksen, N. L., Bue, M., Tøttrup, M., Hanberg, P., Søballe,
K., and Jensen, H. E.: Suppurative Inflammation and Local Tissue Destruction Reduce
the Penetration of Cefuroxime to Infected Bone Implant Cavities, J. Comp.
Pathol., 157, 308–316, https://doi.org/10.1016/j.jcpa.2017.10.001, 2017.
Pautke, C., Tischer, T., Neff, A., Horch, H. H., and Kolk, A.: In vivo tetracycline
labeling of bone: an intraoperative aid in the surgical therapy of
osteoradionecrosis of the mandible, Oral Surg. Oral Med. O., 102, e10-3, https://doi.org/10.1016/j.tripleo.2006.05.007, 2006.
Pautke, C., Bauer, F., Bissinger, O., Tischer, T., Kreutzer, K., Steiner, T., Weitz, J.,
Otto, S., Wolff, K. D., Stürzenbaum, S. R., and Kolk, A.: Tetracycline bone
fluorescence: a valuable marker for osteonecrosis characterization and
therapy, J. Oral Maxillofac. Surg., 68, 125–129, https://doi.org/10.1016/j.joms.2009.05.442, 2010.
Perrin, D. D.: Binding of tetracyclines to bone, Nature, 20, 787–788, https://doi.org/10.1038/208787a0, 1965.
Ristow, O., Otto, S., Geiß, C., Kehl, V., Berger, M., Troeltzsch, M., Koerdt, S.,
Hohlweg-Majert, B., Freudlsperger, C., and Pautke, C.: Comparison of
auto-fluorescence and tetracycline fluorescence for guided bone surgery of
medication-related osteonecrosis of the jaw: a randomized controlled
feasibility study, Int. J. Oral Maxillofac. Surg., 46, 157–166, 2017.
Shaw, J. D., Miller, S., Plourde, A., Shaw, D. L., Wustrack, R., and Hansen, E. N.: Methylene
Blue-Guided Debridement as an Intraoperative Adjunct for the Surgical
Treatment of Periprosthetic Joint Infection, J. Arthroplasty.,
32, 3718–3723, https://doi.org/10.1016/j.arth.2017.07.019,
2017.
Swiontkowski, M. F.: Surgical approaches in osteomyelitis: use of laser Doppler
flowmetry to determine nonviable bone, Infect. Dis. Clin. North Am.,
4, 501–512, 1990.
Weeden, S. H. and Paprosky, W. G.: Minimal 11-year follow-up of extensively
porous-coated stems in femoral revisión total hip arthroplasty, J.
Arthroplasty., 17, 134–137, 2002.
Winkler, T., Stuhlert, M. G. W., Lieb, E., Müller, M., von Roth, P., Preininger, B.,
Trampuz, A., and Perka, C. F.: Outcome of short versus long interval in two-stage
exchange for periprosthetic joint infection: a prospective cohort study,
Arch. Orthop. Trauma Surg., 139, 295–303, https://doi.org/10.1007/s00402-018-3052-4, 2019.
Yoshiga, D., Sasaguri, M., Matsuo, K., Yoshida, S., Uehara, M., Habu, M., Haraguchi, K.,
Tanaka, T., Morimoto, Y., Yoshioka, I., and Tominaga, K.: Fluorescence-guided bone
resection by using Visually Enhanced Lesion Scope in diffuse chronic
sclerosingosteomyelitis of the mandible: Clinical and pathological
evaluation, J. Clin. Exp. Dent., 7, 548–551, 2015a.
Yoshiga, D., Sasaguri, M., Matsuo, K., Kokuryou, S., Habu, M., Oda, M., Kodama, M.,
Tsurushima, H., Sakaguchi, O., Sakurai, T., Tanaka, J., Morimoto, Y., Yoshioka, I., and
Tominaga, K.: Intraoperative detection of viable bone with fluorescence
imaging using Visually Enhanced Lesion Scope in patients with
bisphosphonate-related osteonecrosis of the jaw: clinical and pathological
evaluation, Osteoporos. Int., 26, 1997–2006, 2015b.
Short summary
A plausible cause of persistent infection after septic hip revision may be the presence of nonviable osteomyelitic bone. We present our initial experience in hip revision for chronic infection in which fluorescent tetracycline bone labeling was used as an additional aid to provide a visual index of surgical bone debridement. In the present series, the use of this technique successfully aided the surgeon to detect the presence of nonviable bone.
A plausible cause of persistent infection after septic hip revision may be the presence of...
