Articles | Volume 8, issue 5
https://doi.org/10.5194/jbji-8-209-2023
© Author(s) 2023. 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-8-209-2023
© Author(s) 2023. This work is distributed under
the Creative Commons Attribution 4.0 License.
the Creative Commons Attribution 4.0 License.
Should treatment decisions in septic arthritis of the native hip joint be based on the route of infection?
Fred Ruythooren
CORRESPONDING AUTHOR
Department of Orthopaedic Surgery, University Hospitals Leuven –
Gasthuisberg, Leuven, Belgium
Institute for Orthopaedic Research and Training (IORT), Catholic
University Leuven, Leuven, Belgium
Stijn Ghijselings
Department of Orthopaedic Surgery, University Hospitals Leuven –
Gasthuisberg, Leuven, Belgium
Institute for Orthopaedic Research and Training (IORT), Catholic
University Leuven, Leuven, Belgium
Jordi Cools
Department of Orthopaedic Surgery, University Hospitals Leuven –
Gasthuisberg, Leuven, Belgium
Institute for Orthopaedic Research and Training (IORT), Catholic
University Leuven, Leuven, Belgium
Melissa Depypere
Department of Laboratory Medicine, University Hospitals Leuven –
Gasthuisberg, Leuven, Belgium
Paul De Munter
Department of General Internal Medicine, University Hospitals Leuven – Gasthuisberg, Leuven, Belgium
Department of Microbiology, Immunology and Transplantation, Laboratory for Clinical Infectious and Inflammatory Disorders, KU Leuven, Leuven, Belgium
Willem-Jan Metsemakers
Department of Traumatology, University Hospitals Leuven –
Gasthuisberg, Belgium
Department of Development and Regeneration, KU Leuven, Leuven,
Belgium
Georges Vles
CORRESPONDING AUTHOR
Department of Orthopaedic Surgery, University Hospitals Leuven –
Gasthuisberg, Leuven, Belgium
Institute for Orthopaedic Research and Training (IORT), Catholic
University Leuven, Leuven, Belgium
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Fred Ruythooren, Stijn Ghijselings, Melissa Depypere, Willem-Jan Metsemakers, Liesbet Henckaerts, Nathalie Noppe, and Georges Vles
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The article examines a unique case of Ureaplasma urealyticum causing osteomyelitis in the greater trochanter of a 26-year-old male treated with ocrelizumab for multiple sclerosis. It emphasizes the necessity of a multidisciplinary approach and advanced PCR diagnostics to manage such rare opportunistic infections effectively, highlighting the challenges faced due to the immunosuppressive nature of monoclonal antibody therapies of this kind.
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Septic arthritis (SA) of the native adult hip is a rare orthopaedic emergency. To date, the role of advanced imaging has been confined to supporting or opposing diagnosis; however, implications for surgical decision-making and outcomes have not yet been established. We found that extra-articular abscesses are present in two out of three patients and require varying anatomical approaches. Therefore, we recommend routinely performing advanced imaging in all adults with SA of the native hip joint.
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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.
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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.
Baixing Chen, T. Fintan Moriarty, Hans Steenackers, Georges F. Vles, Jolien Onsea, Thijs Vackier, Isabel Spriet, Rob Lavigne, R. Geoff Richards, and Willem-Jan Metsemakers
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Our research explores natural antimicrobials to combat orthopedic-device-related infections, a challenging issue due to antibiotic resistance. We reviewed agents from bacteria, fungi, viruses, animals, plants and minerals, evaluating their effectiveness and synergy with traditional antibiotics. Our findings suggest these natural alternatives could revolutionize infection management in orthopedic patients, offering new hope for reducing antibiotic resistance and improving treatment outcomes.
Fred Ruythooren, Stijn Ghijselings, Melissa Depypere, Willem-Jan Metsemakers, Liesbet Henckaerts, Nathalie Noppe, and Georges Vles
J. Bone Joint Infect., 9, 167–171, https://doi.org/10.5194/jbji-9-167-2024, https://doi.org/10.5194/jbji-9-167-2024, 2024
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The article examines a unique case of Ureaplasma urealyticum causing osteomyelitis in the greater trochanter of a 26-year-old male treated with ocrelizumab for multiple sclerosis. It emphasizes the necessity of a multidisciplinary approach and advanced PCR diagnostics to manage such rare opportunistic infections effectively, highlighting the challenges faced due to the immunosuppressive nature of monoclonal antibody therapies of this kind.
Jordi Cools, Stijn Ghijselings, Fred Ruythooren, Sander Jentjens, Nathalie Noppe, Willem-Jan Metsemakers, and Georges Vles
J. Bone Joint Infect., 9, 27–35, https://doi.org/10.5194/jbji-9-27-2024, https://doi.org/10.5194/jbji-9-27-2024, 2024
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Septic arthritis (SA) of the native adult hip is a rare orthopaedic emergency. To date, the role of advanced imaging has been confined to supporting or opposing diagnosis; however, implications for surgical decision-making and outcomes have not yet been established. We found that extra-articular abscesses are present in two out of three patients and require varying anatomical approaches. Therefore, we recommend routinely performing advanced imaging in all adults with SA of the native hip joint.
Niels Vanvelk, Esther M. M. Van Lieshout, Jolien Onsea, Jonathan Sliepen, Geertje Govaert, Frank F. A. IJpma, Melissa Depypere, Jamie Ferguson, Martin McNally, William T. Obremskey, Charalampos Zalavras, Michael H. J. Verhofstad, and Willem-Jan Metsemakers
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Related subject area
Subject: Risk factors for bone and joint infections | Topic: All topics
Emergence of rifampicin-resistant staphylococci on the skin and nose of rifampicin-treated patients with an orthopaedic-device-related infection
Wound drainage after arthroplasty and prediction of acute prosthetic joint infection: prospective data from a multicentre cohort study using a telemonitoring app
The unrelenting tide of osteoarticular infections in children: reflections from Uganda, eastern Africa
Arthroplasty after septic arthritis of the native hip and knee: retrospective analysis of 49 joints
The presence of a draining sinus is associated with failure of re-implantation during two-stage exchange arthroplasty
Immunological evaluation of patients with orthopedic infections: taking the Cierny–Mader classification to the next level
Systematic review of risk prediction studies in bone and joint infection: are modifiable prognostic factors useful in predicting recurrence?
Bilateral septic arthritis with rapid progressive destruction of the femoral head after joint injection in rheumatoid arthritis
Alexandra Wallimann, Yvonne Achermann, Ciara Ferris, Mario Morgenstern, Martin Clauss, Vincent Stadelmann, Hannes Andreas Rüdiger, Liam O'Mahony, and Thomas Fintan Moriarty
J. Bone Joint Infect., 9, 191–196, https://doi.org/10.5194/jbji-9-191-2024, https://doi.org/10.5194/jbji-9-191-2024, 2024
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Skin commensal bacteria such as staphylococci are often the source of orthopaedic-device-related infections. Rifampicin is a widely used antibiotic in the treatment of these infections. The results of this study show that oral rifampicin therapy leads to a consistent and persistent induction of resistance in commensal staphylococci on the skin and in the nose for a prolonged time.
Henk Scheper, Rachid Mahdad, Brenda Elzer, Claudia Löwik, Wierd Zijlstra, Taco Gosens, Joris C. T. van der Lugt, Robert J. P. van der Wal, Rudolf W. Poolman, Matthijs P. Somford, Paul C. Jutte, Pieter K. Bos, Richard E. Zwaan, Rob G. H. H. Nelissen, Leo G. Visser, Mark G. J. de Boer, and the wound care app study group
J. Bone Joint Infect., 8, 59–70, https://doi.org/10.5194/jbji-8-59-2023, https://doi.org/10.5194/jbji-8-59-2023, 2023
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The relation between postoperative wound leakage and occurrence of a prosthetic joint infection (PJI) after arthroplasty has not been investigated in a prospective study. We performed a large cohort study in which 1019 patients, after arthroplasty, recorded their wound drainage status in a wound care app during 30 postoperative days. Risk factors for wound drainage were identified. Moderate to heavy wound leakage in the third postoperative week was strongly associated with the occurrence of PJI.
Antonio Loro
J. Bone Joint Infect., 7, 183–185, https://doi.org/10.5194/jbji-7-183-2022, https://doi.org/10.5194/jbji-7-183-2022, 2022
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Forty years ago I made a radical professional choice: to dedicate a few years of practice to the African continent. Not surprisingly, a few years became many. This paper is dedicated to the children who are battling osteoarticular infections and to those who will be struggling with them in future.
Elodie Portier, Valérie Zeller, Younes Kerroumi, Beate Heym, Simon Marmor, and Pascal Chazerain
J. Bone Joint Infect., 7, 81–90, https://doi.org/10.5194/jbji-7-81-2022, https://doi.org/10.5194/jbji-7-81-2022, 2022
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Arthroplasty after septic arthritis (SA) raises diagnostic and therapeutic questions. We report on 49 knee and hip arthroplasties following SA. Median SA-to-arthroplasty interval was 32 weeks, and one-stage arthroplasty was performed in 43 episodes. No SA relapse but 5 new prosthetic joint infections occurred with an infection-free survival rate of 96 % at 2 years. Arthroplasty may be a post-SA option, even within a short period of time but requires specific management and prolonged monitoring.
Alexandra S. Gabrielli, Alan E. Wilson, Richard A. Wawrose, Malcolm Dombrowski, Michael J. O'Malley, and Brian A. Klatt
J. Bone Joint Infect., 7, 55–60, https://doi.org/10.5194/jbji-7-55-2022, https://doi.org/10.5194/jbji-7-55-2022, 2022
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Prosthetic joint infection is a complicated problem, where reinfection can occur. Understanding risk factors for failure helps optimize care. This study investigated if the presence of a draining sinus tract was correlated with failure of two-stage revision. Previous cases were reviewed at our institution over a 10-year period. Patients with a sinus tract were significantly less likely to be replanted compared to those without a sinus tract at presentation.
Janet D. Conway, Vache Hambardzumyan, Nirav G. Patel, Shawn D. Giacobbe, and Martin G. Gesheff
J. Bone Joint Infect., 6, 433–441, https://doi.org/10.5194/jbji-6-433-2021, https://doi.org/10.5194/jbji-6-433-2021, 2021
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Adding immunologic evaluation to the Cierny–Mader classification more accurately determines patients’ true host status and better quantifies risk and outcome with respect to orthopedic infection. Immunologically deficient A hosts should be quantified as B hosts. IgG deficiencies can be addressed with supplementation. IgG replacement should be considered in patients with recurrent orthopedic infections.
Maria Dudareva, Andrew Hotchen, Martin A. McNally, Jamie Hartmann-Boyce, Matthew Scarborough, and Gary Collins
J. Bone Joint Infect., 6, 257–271, https://doi.org/10.5194/jbji-6-257-2021, https://doi.org/10.5194/jbji-6-257-2021, 2021
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Clinical prognostic models are tools that predict treatment outcomes for individual patients. For adults with bone and joint infection treated with surgery and implant removal, this review found no existing unbiased clinical prediction models that took modifiable health factors into account to estimate prognosis. Developing a clinical prognostic model may help treatment decisions and future targeted research in orthopaedic infection.
Viola Freigang, Florian Baumann, and Volker Alt
J. Bone Joint Infect., 6, 255–256, https://doi.org/10.5194/jbji-6-255-2021, https://doi.org/10.5194/jbji-6-255-2021, 2021
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We report on a clinical case of rapid progressive destruction of the femoral head
after joint injection in rheumatoid arthritis.
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2006.
Short summary
A total of 41 patients who underwent surgical treatment for septic arthritis (SA) of the native hip were studied. We show that patients with SA of the native hip can be divided in three distinct clinical subgroups based on route of infection. Route of infection is directly related to the chance of femoral head preservation and should, therefore, be the basis for decision-making. Only patients with blood-borne infections in an undamaged hip had a reasonable chance of femoral head preservation.
A total of 41 patients who underwent surgical treatment for septic arthritis (SA) of the native...