Treatment of patients with periprosthetic infection

Authors

  • Alexander Dulaev Pavlov First Saint Petersburg State Medical University, 6–8, ul. L’va Tolstogo, St. Petersburg, 197022, Russian Federation
  • Alexandr Tsed Pavlov First St. Petersburg State Medical University, 6–8, ul. L’va Tolstogo, St. Petersburg, 197022, Russian Federation
  • Dmitriy Dulaev Pavlov First St. Petersburg State Medical University, 6–8, ul. L’va Tolstogo, St. Petersburg, 197022, Russian Federation
  • Andrey Ovdenko Pavlov First Saint Petersburg State Medical University, 6–8, ul. L’va Tolstogo, St. Petersburg, 197022, Russian Federation ; Hospital for War Veterans, 21, ul. Narodnaya, St. Petersburg, 193079, Russian Federation
  • Nikita Mushtin Pavlov First St. Petersburg State Medical University, 6–8, ul. L’va Tolstogo, St. Petersburg, 197022, Russian Federation
  • Sergey Varzin St. Petersburg State University, 7–9, Universitetskaya nab., St. Petersburg, 199034, Russian Federation ; St. Petersburg Medico-Social Institute, 72а, Kondratevsky pr., St. Petersburg, 195271, Russian Federation

DOI:

https://doi.org/10.21638/doi.org/10.21638/spbu11.2023.403

Abstract

The review article presents the main questions of pathogenesis, early diagnosis, and surgical management of patients with paraprosthetic infection that developed after surgery for fractured limb bones and deforming arthrosis. The main factors that influenced the occurrence of purulent complications and the ways of their prevention, treatment, taking into account the current ideas about wound infection, are indicated. Pathogenetic mechanisms of paraprosthetic infection development are directly related to the presence of hematoma in the operated joint. Risk factors for large joint arthroplasty can be divided into three conditional types: general and local patient status; conditions for the operation; features of surgery. To detail the risk factors associated with the general or local status of the patient, two subtypes are highlighted — primary and secondary. The main subtype includes: 1) focus infection, located in the operated joint; 2) focus infection, located in the paraarticular tissues of the operated joint; 3) generalization of the infectious process —
sepsis. The additional subtype includes: 1) history of previous joint surgery; 2) critical changes in body mass index; 3) uncontrolled diabetes mellitus; 4) presence of systemic diseases associated with prolonged administration of glucocorticosteroids and cytostatics and others. Two-stage revision endoprosthesis in patients with chronic periprosthetic infection is the gold standard to date. In many ways, the success of treatment depends on the correctness of all stages, on the adequacy of diagnostic measures, the scrupulousness of compliance with surgical technique and is determined by the surgeon’s experience, as well as the equipment of the hospital.

Keywords:

paraprosthetic infection, periprosthetic infection, fracture, limb bones, deforming arthrosis, transplant, purulent complications, wound infection, diagnosis, treatment, prognosis

Downloads

Download data is not yet available.
 

References

Литература

Arens S., Hansis M., Schlegel U., Eijer H., Printzen G., Ziegler W. J., Perren S. M. Infection after open reduction and internal fixation with dynamic compression plates — clinical and experimental // Injury.1996. Vol. 27, no. 3. P. 27–33. https://doi.org/10.1016/0020-1383(96)89029-2

Шаповалов В. М., Овденко А. Г. Огнестрельный остеомиелит. СПб.: Морсар АВ, 2000. 143 с.

Военная травматология и ортопедия / под ред. В. М. Шаповалова. СПб.: ВМедА, 2013. 547 с.

Материалы Второй международной согласительной конференции по скелетно-мышечной инфекции / под ред. Р. М. Тихилова, С. А. Божковой, И. И. Шубнякова. СПб.: РНИИТО им. Р. Р. Вредена, 2019. 314 с.

Руководство по хирургии тазобедренного сустава. Т. 2 / под ред. Р. М. Тихилова, И. И. Шубнякова. СПб.: ЭЛБИ-СПб, 2015. 356 c.

Травматология и ортопедия / под ред. Н. В. Корнилова, А. К. Дулаева. М.: ГЭОТАР-медиа, 2020.655 с.

Kempthorne J. T., Ailabouni R., Raniga S., Hammer D., Hooper G. Occult infection in aseptic joint loosening and the diagnostic role of implant sonication // BioMed Research Internation. 2015.Vol. 217. P. 213–218.

Цед А. Н., Дулаев А. К. Первичное эндопротезирование тазобедренного сустава у больных с терминальной стадией хронической болезни почек (обзор литературы) // Травматология и ортопедия России. 2018. Т. 24, № 2. C. 146–153.

Цед А. Н., Дулаев А. К., Муштин Н. Е., Тишков А. В. Особенности диагностики костно-суставной патологии при эндопротезировании тазобедренного и коленного суставов у пациентов, находящихся на хроническом гемодиализе // Ученые записки Первого Санкт-Петербургского государственного медицинского университета имени академика И. П. Павлова. 2019. Т. 26, № 2.С. 28–36.

Дулаев А. К., Овденко А. Г., Цед А. Н., Муштин Н. Е. Периимплантатные инфекционные осложнения в травматологии и ортопедии. СПб.: РНЦПСбГМУ, 2023. 52 с.

Darouiche R. O. Treatment of infections associated with surgical implants // N. Engl. J. Med. 2004.Vol. 350, no. 14. P. 1422–1429. https://doi.org/10.1056/NEJMra035415

Stephen K. L., Borens O. Principles of Orthopedic infection Management. New York, 2016. 482 p.

Morrissy R. T. , Haynes D. W. Acute hematogenous osteomyelitis: A model with trauma as an etiology// J. Pediatr. Orthop. 1989. Vol. 9, no. 4. P. 447–456.

Овденко А. Г. Огнестрельные ранения и огнестрельный остеомиелит конечностей СПб.: Искусство России, 2010. 239 с.

Шаповалов В. М., Овденко А. Г., Хоминец В. В. Внешний остеосинтез при лечении раненых.СПб.: Профессионал, 2013. 283 c.

Canale S. T., Beaty J. H. Campbell’s Operative Orthopaedics. Vol. 1. [S. l.]: Mosby, Elsevier, 2008. 1060 p.

Куропаткин Г. В. Костный цемент в травматологии и ортопедии. М.: Авторский тираж, 2018.200 с.

Illingworth K. D., Mihalko W. M., Parvizi J., Sculco Th., McArthur B., el Bitar Y., Saleh K. J. How to minimize infection and there by maximize patient outcomes in total joint arthroplasty: A multicenter approach: AAOS exhibit selection // J. Bone Jt. Surg. 2013. Vol. 95, no. 8. P. 50.

Li С., Renz N., Trampuz A. Management of Periprosthetic Joint Infection // Hip Pelvis. 2018. Vol. 30,no. 3. P. 138–146.

Schafroth M., Zimmerli W., Brunazzi M., Ochsner P. E. Infection // Total hip replacement. Berlin:Springer-Verlag, 2003. P. 65–90.

Tsukayama D. T., Goldberg V. M., Kyle R. Diagnosis and management of infection after total knee arthroplasty // J. Bone Jt. Surg. Am. 2003. Vol. 85-A, no. 4. P. 75–80.

Zimmerli W., Widmer A. F., Blatter M., Frei R., Ochsner P. E. Role of rifampin for treatment of orthopedic implant-related staphylococcal infections: a randomized controlled trial. Foreign-Body Infection (FBI) Study Group // JAMA. 1998. Vol. 279, no. 19. P. 1537–1541.

Ochsner P. E., Yailemariam S. Histology of osteosynthesis related bone infection // Injury. 2006. Vol. 37,no. 2. P. 49–58.

Willenegger H., Roth B., Ochsner P. E. The return of local antiseptics in surgery // Injury. 1995. Vol. 26,suppl. 1. P. 28–33.

Шубняков И. И., Тихилов Р. М., Денисов А. О., Ахмедилов М. А., Черный А. Ж., Тотоев З. А., Джавадов А. А., Карпухин А. С., Муравьёва Ю. В. Что изменилось в структуре ревизионного эндопротезирования тазобедренного сустава в последние годы? // Травматология и ортопедия России. 2019. Т. 25, № 4. C. 9–27.


References

Arens S., Hansis M., Schlegel U., Eijer H., Printzen G., Ziegler W. J., Perren S. M. Infection after open reduction and internal fixation with dynamic compression plates — clinical and experimental. Injury,1996, vol. 27, no. 3, pp. 27–33. https://doi.org/10.1016/0020-1383(96)89029-2

Shapovalov V. M., Ovdenko A. G. Gunshot osteomyelitis. St. Petersburg, Morsar AV Publ., 2000, 143 p.(In Russian)

Military traumatology and orthopedics, ed. V. M. Shapovalov St. Petersburg, VMedA Publ., 2013, 547 p.(In Russian)

Proceedings of the Second International Conciliation Meeting on Musculoskeletal Infection, eds R. M. Tikhilov, S. A. Bozhkova, I. I. Shubnyakov. Rus. ed. St. Petersburg, RNIITO named after R. R. Vreden Publ., 2019, 314 p. (In Russian)

Guide to hip joint surgery, vol. 2, eds R. M. Tikhilov, I. I. Shubnyakov. St. Petersburg, ELBI-Spb Publ.,2015, 356 p. (In Russian)

Traumatology and orthopedics, eds N. V. Kornilov, A. K. Dulaev. Moscow, GEOTAR-media Publ., 2020,655 p. (In Russian)

Kempthorne J. T., Ailabouni R., Raniga S., Hammer D., Hooper G. Occult infection in aseptic joint loosening and the diagnostic role of implant sonication. BioMed Research Internation, 2015, vol. 217,pp. 213–218.

Tsed A. N., Dulaev A. K. Primary hip replacement in patients with end-stage chronic kidney disease (literature review). Traumatology and Orthopedics of Russia, 2018, vol. 24, no. 2, pp. 146–153. (In Russian)

Tsed A. N., Dulaev A. K., Mushtin N. E., Tishkov A. V. Features of diagnostics of bone-joint pathology in hip and knee arthroplasty in patients undergoing chronic hemodialysis. Scientific notes of the 1st St. Petersburg State Medical University named after I. P. Pavkov the catch, 2019, vol. 26, no. 2, pp. 28–36.(In Russian)

Dulaev A. K., Ovdenko A. G., Tsed A. N., Mushtin N. E. Periimplantate infectious complications in traumatology and orthopedics. St. Petersburg, RNTSPSbGMU Press, 2023, 52 p. (In Russian)

Darouiche R. O. Treatment of infections associated with surgical implants. N. Engl. J. Med., 2004,vol. 350, no. 14, pp. 1422–1429. https://doi.org/10.1056/NEJMra035415

Stephen K. L., Borens O. Principles of Orthopedic infection Management. [S. l.], Thieme, 2016, 496 p.

Morrissy R. T., Haynes D. W. Acute hematogenous osteomyelitis: A model with trauma as an etiology.J. Pediatr. Orthop., 1989, vol. 9, no. 4, pp. 447–456.

Ovdenko A. G. Gunshot wounds and gunshot osteomyelitis of the extremities. St. Petersburg, Iskusstvo Rossii Publ., 2010, 39 p. (In Russian)

Shapovalov V. M., Ovdenko A. G., Khominets V. V. External osteosynthesis in the treatment of the wounded. St. Petersburg, Professional Publ., 2013, 283 p. (In Russian)

Canale S. T., Beaty J. H. Campbell ’s Operative Orthopaedics, vol. 1. [S. l.], Mosby, Elsevier, 2008, 1060 p.

Kuropatkin G. V. Bone cement in traumatology and orthopedics. Moscow, Avtorskii tirazh Publ., 2018,200 p. (In Russian)

Illingworth K. D., Mihalko W. M., Parvizi J., Sculco Th., McArthur B., el Bitar Y., Saleh K. J. How to minimize infection and there by maximize patient outcomes in total joint arthroplasty: A multicenter approach: AAOS exhibit selection. J. Bone Jt. Surg., 2013, vol. 95, no. 8, p. 50.

Li С., Renz N., Trampuz A. Management of Periprosthetic Joint Infection. Hip Pelvis, 2018, vol. 30,no. 3, pp. 138–146.

Schafroth M., Zimmerli W., Brunazzi M., Ochsner P. E. Infection. Total hip replacement. Berlin, Springer-Verlag, 2003, pp. 65–90.

Tsukayama D. T., Goldberg V. M., Kyle R. Diagnosis and management of infection after total knee arthroplasty. J. Bone Jt. Surg. Am., 2003, vol. 85-A, no. 4, pp. 75–80.

Zimmerli W., Widmer A. F., Blatter M., Frei R., Ochsner P. E. Role of rifampin for treatment of orthopedic implant-related staphylococcal infections: a randomized controlled trial. Foreign-Body Infection (FBI) Study Group. JAMA, 1998, vol. 279, no. 19, pp. 1537–1541.

Ochsner P. E., Yailemariam S. Histology of osteosynthesis related bone infection. Injury, 2006, vol. 37,no. 2, pp. 49–58.

Willenegger H., Roth B., Ochsner P. E. The return of local antiseptics in surgery. Injury, 1995, vol. 26,suppl. 1, pp. 28–33.

Shubnyakov I. I., Tikhilov R. M., Denisov A. O., Akhmedilov M. A., Cherny A. Z., Totoev Z. A., Javadov A. A., Karpukhin A. S., Muravyova Yu. V. What has changed in the structure of revision hip replacement in recent years? Traumatology and orthopedics of Russia, 2019, vol. 25, no. 4, pp. 9–27.(In Russian)

Downloads

Published

2024-03-20

How to Cite

Dulaev, A. ., Tsed, A. ., Dulaev, D. ., Ovdenko, A. ., Mushtin, N. ., & Varzin, S. (2024). Treatment of patients with periprosthetic infection. Vestnik of Saint Petersburg University. Medicine, 18(4), 372–384. https://doi.org/10.21638/doi.org/10.21638/spbu11.2023.403

Issue

Vol. 18 No. 4 (2023)

Section

Surgery

License

Articles of "Vestnik of Saint Petersburg University. Medicine" are open access distributed under the terms of the License Agreement with Saint Petersburg State University, which permits to the authors unrestricted distribution and self-archiving free of charge.