Articles | Volume 7, issue 1
https://doi.org/10.5194/jbji-7-33-2022
© Author(s) 2022. 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-7-33-2022
© Author(s) 2022. This work is distributed under
the Creative Commons Attribution 4.0 License.
the Creative Commons Attribution 4.0 License.
Black pus from a worn-out elbow arthroplasty
Marjan Wouthuyzen-Bakker
CORRESPONDING AUTHOR
Department of Medical Microbiology and Infection Prevention, University of
Groningen, University Medical Center Groningen, Groningen, the Netherlands
Alexander L. Boerboom
Department of Orthopaedic Surgery, University of Groningen, University
Medical Center Groningen, Groningen, the Netherlands
Related authors
Irene K. Sigmund, Marjan Wouthuyzen-Bakker, Tristan Ferry, Willem J. 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 J. 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.
Sebastian Simon, Marjan Wouthuyzen-Bakker, Susana Gardete Hartmann, Jennyfer A. Mitterer, Sujeesh Sebastian, Stephanie Huber, Bernhard J. H. Frank, and Jochen G. Hofstaetter
J. Bone Joint Infect., 10, 51–59, https://doi.org/10.5194/jbji-10-51-2025, https://doi.org/10.5194/jbji-10-51-2025, 2025
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We compared the re-revision rates in rTHA and rTKA (revison total hip and knee arthroplasty) with and without AB (antibiotic) treatment in patients with UPICs (unexpected positive intraoperative cultures). The re-revision rate between the AB group and the non-AB group was similar. Postoperative AB treatment did not result in a decreased re-revision rate in patients with UPICs in presumed aseptic rTHA and rTKA. Patients with pathogens classified as a likely contaminant can be safely ignored.
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.
Stéphanie Pascual, Brooklyn Noble, Nusreen Ahmad-Saeed, Catherine Aldridge, Simone Ambretti, Sharon Amit, Rachel Annett, Shaan Ashk O'Shea, Anna Maria Barbui, Gavin Barlow, Lucinda Barrett, Mario Berth, Alessandro Bondi, Nicola Boran, Sara E. Boyd, Catarina Chaves, Martin Clauss, Peter Davies, Ileana T. Dianzo-Delgado, Jaime Esteban, Stefan Fuchs, Lennart Friis-Hansen, Daniel Goldenberger, Andrej Kraševac Glaser, Juha O. Groonroos, Ines Hoffmann, Tomer Hoffmann, Harriet Hughes, Marina Ivanova, Peter Jezek, Gwennan Jones, Zeynep Ceren Karahan, Cornelia Lass-Flörl, Frédéric Laurent, Laura Leach, Matilde Lee Horsbøll Pedersen, Caroline Loiez, Maureen Lynch, Robert J. Maloney, Martin Marsh, Olivia Milburn, Shanine Mitchell, Luke S. P. Moore, Lynn Moffat, Marianna Murdjeva, Michael E. Murphy, Deepa Nayar, Giacomo Nigrisoli, Fionnuala O'Sullivan, Büşra Öz, Teresa Peach, Christina Petridou, Mojgan Prinz, Mitja Rak, Niamh Reidy, Gian Maria Rossolini, Anne-Laure Roux, Patricia Ruiz-Garbajosa, Kordo Saeed, Llanos Salar-Vidal, Carlos Salas Venero, Mathyruban Selvaratnam, Eric Senneville, Peter Starzengruber, Ben Talbot, Vanessa Taylor, Rihard Trebše, Deborah Wearmouth, Birgit Willinger, Marjan Wouthuyzen-Bakker, Brianne Couturier, and Florence Allantaz
J. Bone Joint Infect., 9, 87–97, https://doi.org/10.5194/jbji-9-87-2024, https://doi.org/10.5194/jbji-9-87-2024, 2024
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This study conducted in multiple sites across Europe aimed to evaluate the BIOFIRE Joint Infection (JI) Panel, a new technology that uses multiplex PCR to detect microorganisms in synovial fluid of patients with suspicion of joint infections in 1 h, in comparison with synovial fluid culture. Results showed an overall agreement of 85 % to 88.4 % between the two methods. The JI Panel detected additional organisms, and the positive user experience highlights its clinical significance.
Jorrit Willem Adriaan Schoenmakers, Rosanne de Boer, Lilli Gard, Greetje Anna Kampinga, Marleen van Oosten, Jan Maarten van Dijl, Paulus Christiaan Jutte, and Marjan Wouthuyzen-Bakker
J. Bone Joint Infect., 8, 45–50, https://doi.org/10.5194/jbji-8-45-2023, https://doi.org/10.5194/jbji-8-45-2023, 2023
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In a first evaluation, the accuracy of a novel multiplex PCR (polymerase chain reaction) panel for rapid detection of pathogens in patients with a clinical suspicion of acute septic arthritis of native and prosthetic joints is assessed. Clear benefit is seen in patients with a suspected native septic arthritis and late acute prosthetic joint infection. This indicates that the panel allows for fast tailoring of antibiotics and may prompt the surgeon for surgical lavage in doubtful clinical cases.
Karsten D. Ottink, Stefan J. Gelderman, Marjan Wouthuyzen-Bakker, Joris J. W. Ploegmakers, Andor W. J. M. Glaudemans, and Paul C. Jutte
J. Bone Joint Infect., 7, 1–9, https://doi.org/10.5194/jbji-7-1-2022, https://doi.org/10.5194/jbji-7-1-2022, 2022
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A low-grade periprosthetic joint infection (PJI) may be difficult to diagnose, and nuclear imaging could help in the diagnosis. However, its diagnostic value is unclear. We retrospectively evaluated this diagnostic value. We conclude that in patients presenting with nonspecific symptoms and a low a priori chance of PJI based on clinical evaluation, nuclear imaging is of no clear added value in diagnosing a PJI.
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
Irene K. Sigmund, Marjan Wouthuyzen-Bakker, Tristan Ferry, Willem J. 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
Short summary
Short summary
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 J. 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
Short summary
Short summary
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.
Sebastian Simon, Marjan Wouthuyzen-Bakker, Susana Gardete Hartmann, Jennyfer A. Mitterer, Sujeesh Sebastian, Stephanie Huber, Bernhard J. H. Frank, and Jochen G. Hofstaetter
J. Bone Joint Infect., 10, 51–59, https://doi.org/10.5194/jbji-10-51-2025, https://doi.org/10.5194/jbji-10-51-2025, 2025
Short summary
Short summary
We compared the re-revision rates in rTHA and rTKA (revison total hip and knee arthroplasty) with and without AB (antibiotic) treatment in patients with UPICs (unexpected positive intraoperative cultures). The re-revision rate between the AB group and the non-AB group was similar. Postoperative AB treatment did not result in a decreased re-revision rate in patients with UPICs in presumed aseptic rTHA and rTKA. Patients with pathogens classified as a likely contaminant can be safely ignored.
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
Short summary
Short summary
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.
Stéphanie Pascual, Brooklyn Noble, Nusreen Ahmad-Saeed, Catherine Aldridge, Simone Ambretti, Sharon Amit, Rachel Annett, Shaan Ashk O'Shea, Anna Maria Barbui, Gavin Barlow, Lucinda Barrett, Mario Berth, Alessandro Bondi, Nicola Boran, Sara E. Boyd, Catarina Chaves, Martin Clauss, Peter Davies, Ileana T. Dianzo-Delgado, Jaime Esteban, Stefan Fuchs, Lennart Friis-Hansen, Daniel Goldenberger, Andrej Kraševac Glaser, Juha O. Groonroos, Ines Hoffmann, Tomer Hoffmann, Harriet Hughes, Marina Ivanova, Peter Jezek, Gwennan Jones, Zeynep Ceren Karahan, Cornelia Lass-Flörl, Frédéric Laurent, Laura Leach, Matilde Lee Horsbøll Pedersen, Caroline Loiez, Maureen Lynch, Robert J. Maloney, Martin Marsh, Olivia Milburn, Shanine Mitchell, Luke S. P. Moore, Lynn Moffat, Marianna Murdjeva, Michael E. Murphy, Deepa Nayar, Giacomo Nigrisoli, Fionnuala O'Sullivan, Büşra Öz, Teresa Peach, Christina Petridou, Mojgan Prinz, Mitja Rak, Niamh Reidy, Gian Maria Rossolini, Anne-Laure Roux, Patricia Ruiz-Garbajosa, Kordo Saeed, Llanos Salar-Vidal, Carlos Salas Venero, Mathyruban Selvaratnam, Eric Senneville, Peter Starzengruber, Ben Talbot, Vanessa Taylor, Rihard Trebše, Deborah Wearmouth, Birgit Willinger, Marjan Wouthuyzen-Bakker, Brianne Couturier, and Florence Allantaz
J. Bone Joint Infect., 9, 87–97, https://doi.org/10.5194/jbji-9-87-2024, https://doi.org/10.5194/jbji-9-87-2024, 2024
Short summary
Short summary
This study conducted in multiple sites across Europe aimed to evaluate the BIOFIRE Joint Infection (JI) Panel, a new technology that uses multiplex PCR to detect microorganisms in synovial fluid of patients with suspicion of joint infections in 1 h, in comparison with synovial fluid culture. Results showed an overall agreement of 85 % to 88.4 % between the two methods. The JI Panel detected additional organisms, and the positive user experience highlights its clinical significance.
Jorrit Willem Adriaan Schoenmakers, Rosanne de Boer, Lilli Gard, Greetje Anna Kampinga, Marleen van Oosten, Jan Maarten van Dijl, Paulus Christiaan Jutte, and Marjan Wouthuyzen-Bakker
J. Bone Joint Infect., 8, 45–50, https://doi.org/10.5194/jbji-8-45-2023, https://doi.org/10.5194/jbji-8-45-2023, 2023
Short summary
Short summary
In a first evaluation, the accuracy of a novel multiplex PCR (polymerase chain reaction) panel for rapid detection of pathogens in patients with a clinical suspicion of acute septic arthritis of native and prosthetic joints is assessed. Clear benefit is seen in patients with a suspected native septic arthritis and late acute prosthetic joint infection. This indicates that the panel allows for fast tailoring of antibiotics and may prompt the surgeon for surgical lavage in doubtful clinical cases.
Karsten D. Ottink, Stefan J. Gelderman, Marjan Wouthuyzen-Bakker, Joris J. W. Ploegmakers, Andor W. J. M. Glaudemans, and Paul C. Jutte
J. Bone Joint Infect., 7, 1–9, https://doi.org/10.5194/jbji-7-1-2022, https://doi.org/10.5194/jbji-7-1-2022, 2022
Short summary
Short summary
A low-grade periprosthetic joint infection (PJI) may be difficult to diagnose, and nuclear imaging could help in the diagnosis. However, its diagnostic value is unclear. We retrospectively evaluated this diagnostic value. We conclude that in patients presenting with nonspecific symptoms and a low a priori chance of PJI based on clinical evaluation, nuclear imaging is of no clear added value in diagnosing a PJI.
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
Short summary
Short summary
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: Aetiology
Soft-tissue thickness radiographic measurement: a marker to evaluate acute periprosthetic joint infection risk in total hip replacement
Revision for periprosthetic joint infection rate stratified by seasonality of operation in a national population of total and unicompartmental knee arthroplasty patients: a register-based analysis
Laura Rey Fernández, Francesc Angles Crespo, Silvia María Miguela Álvarez, Martí Carles Bernaus-Johnson, Agustí Bartra Ylla, and Lluís Font-Vizcarra
J. Bone Joint Infect., 6, 211–217, https://doi.org/10.5194/jbji-6-211-2021, https://doi.org/10.5194/jbji-6-211-2021, 2021
Short summary
Short summary
Our objective was to analyze if patients with larger soft-tissue thickness measured in X-rays have greater risk of acute infection after hip arthroplasty. We reviewed acute-infection patients in our institution over 6 years and selected 2 patients with similar demographics that were not infected for each case. Larger measurements showed association with acute infection. This easily obtainable measurement might provide helpful data in making preoperative risk assessments and prevention programs.
Julius Tetens Hald, Anne Brun Hesselvig, Andreas Kryger Jensen, and Anders Odgaard
J. Bone Joint Infect., 6, 111–117, https://doi.org/10.5194/jbji-6-111-2021, https://doi.org/10.5194/jbji-6-111-2021, 2021
Short summary
Short summary
Deep periprosthetic joint infection following knee replacement is a serious complication feared by surgeons. Our aim was to investigate if seasonality of deep infection incidence exists in a national registry of knee replacement patients. We extracted data from over 100 000 procedures, investigating if patients operated on during the summer had increased risk of re-operation due to infection. We found no signal of periodicity, meaning the summer season is not a risk factor for deep infection.
Cited articles
Barba, T., Wach, J., Lustig, S., Laurent, F., Devouassoux-Shisheboran, M., Valour, F., Chidiac, C., Ferry, T., and Lyon BJI Study Group: Metallosis-associated prosthetic joint infection, Med. Mal. Infect.,
11–12, 484–487, 2015.
Brinkman, J. M., de Vos, M. J., and Eygendaal, D.: Failure mechanisms in uncemented Kudo
type 5 elbow prosthesis in patients with rheumatoid arthritis, Acta
Orthop., 78, 263–270, 2007.
Tai, D. B. G., Patel, R., Abdel, M. P., Berbari, E. F., and Tande, A. J.: Microbiology of hip and
knee periprosthetic joint infections: a database study, Clin. Microbiol.
Infect., 28, P255–259, https://doi.org/10.1016/j.cmi.2021.06.006, 2021.
Short summary
This case illustrates the clinical picture of a worn-out elbow prosthesis resulting in severe metallosis and a subsequent periprosthetic joint infection.
This case illustrates the clinical picture of a worn-out elbow prosthesis resulting in severe...