Journal of Bone and Joint Infection最新文献

{"title":"No difference in failure between static, articulating, and prosthetic low-friction spacers for periprosthetic joint infection of total knee arthroplasty.","authors":"Michael F Shannon, Timothy Edwards, Timothy Maurer, Andrew J Frear, Victoria R Wong, Shaan Sadhwani, Clair Smith, Anthony Kamson, Brian Omslaer, Christian Cisneros, Andrew Gordon, Akeem Williams, Neel B Shah, Kenneth L Urish","doi":"10.5194/jbji-10-243-2025","DOIUrl":"https://doi.org/10.5194/jbji-10-243-2025","url":null,"abstract":"<p><p><b>Introduction</b>: Two-stage revision with an antibiotic spacer is the gold-standard treatment of prosthetic joint infection (PJI) for total knee arthroplasty (TKA). Multiple spacer designs exist, including static, articulated, and prosthetic low-friction (PALF) spacers. However, current literature is limited on variant superiority for infection eradication. This study aimed to compare outcomes of two-stage exchange for TKA PJI between patients with static cement, articulated cement, and PALF spacers. <b>Methods</b>: This retrospective study included 93 patients who underwent two-stage revision for PJI following primary TKA and received a static ( <math><mrow><mi>n</mi> <mo>=</mo> <mn>17</mn></mrow> </math> ), articulating ( <math><mrow><mi>n</mi> <mo>=</mo> <mn>54</mn></mrow> </math> ), or low-friction ( <math><mrow><mi>n</mi> <mo>=</mo> <mn>22</mn></mrow> </math> ) spacer. The primary outcome was failure at 2 years, defined as spacer retention, reoperation, or death. Secondary outcomes included reimplantation and discontinued antibiotics by 1 year, time to failure, duration of hospital stay, functional measures, and adverse events. Outcomes were compared between groups using hypothesis testing for continuous or categorical measures. <b>Results</b>: At 2 years, no significant difference in failure was seen for static (58.82 %), articulating (35.19 %), and PALF (22.73 %) spacers ( <math><mrow><mi>p</mi> <mo>=</mo> <mn>0.064</mn></mrow> </math> ). Articulating spacers demonstrated greater range of motion than static spacers at the final follow-up ( <math><mrow><mi>p</mi> <mo>=</mo> <mn>0.0</mn></mrow> </math> 3). Static spacers were associated with a higher adverse-event frequency ( <math><mrow><mi>p</mi> <mo>=</mo> <mn>0.03</mn></mrow> </math> ). No other significant differences in outcomes were observed (all <math><mrow><mi>p</mi> <mo>></mo> <mn>0.05</mn></mrow> </math> ). <b>Conclusions</b>: The three spacer variants demonstrated similar failure rates for two-stage revision of TKA PJI at 2 years. Static spacers may lead to adverse events more frequently compared to other designs, and a longer interstage duration for prosthetic spacers may reflect greater functionality.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"10 4","pages":"243-253"},"PeriodicalIF":2.8,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12311390/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144760224","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Proactive Therapeutic Drug MONiToring to Guide Suppressive Antibiotic Therapy with DALBAvaNcin ( > 12 weeks) in Osteoarticular Infections (MONTALBANO).","authors":"Chiara Mariani, Matteo Passerini, Lucia Galli, Alice Covizzi, Marta Colaneri, Martina Offer, Margherita Faenzi, Stefania Merli, Simona Landonio, Marta Fusi, Alberto Dolci, Andrea Gori, Dario Cattaneo","doi":"10.5194/jbji-10-255-2025","DOIUrl":"https://doi.org/10.5194/jbji-10-255-2025","url":null,"abstract":"<p><p><b>Introduction</b>: Long-term dalbavancin use is increasingly adopted off-label for osteoarticular infections (OAIs), but data on administration timing and long-term effects beyond 12 weeks are scarce. This study evaluated the pharmacological efficacy of proactive therapeutic drug monitoring (TDM) to optimize dalbavancin administration. <b>Methods</b>: This single-center, retrospective study included adult OAI patients treated with <math><mrow><mo>≥</mo> <mn>4</mn></mrow> </math> doses of dalbavancin from July 2022 to October 2024. Initial doses were given on days 1, 8, and 43. From the third dose onward, <math> <mrow><msub><mi>C</mi> <mo>min⁡</mo></msub> </mrow> </math> and <math> <mrow><msub><mi>C</mi> <mo>max⁡</mo></msub> </mrow> </math> values informed dosing schedules via log-linear regression models, targeting <math> <mrow><msub><mi>C</mi> <mo>min⁡</mo></msub> <mo>≥</mo> <mn>8</mn></mrow> </math> mg L^-1. The primary outcome was the pharmacological efficacy of dalbavancin, assessed by the proportion of patients with <math> <mrow><msub><mi>C</mi> <mo>min⁡</mo></msub> <mo>≥</mo> <mn>8</mn></mrow> </math> mg L^-1 and <math><mrow><mo>≥</mo> <mn>4</mn></mrow> </math> mg L^-1 after the third dose. Clinical outcomes and safety data were collected as descriptive data. <b>Results</b>: A total of 33 patients provided 118 <math> <mrow><msub><mi>C</mi> <mo>min⁡</mo></msub> </mrow> </math> determinations. Pharmacological efficacy was achieved in 93 <math><mo>/</mo></math> 118 (78.8 %) and 114 <math><mo>/</mo></math> 118 (96.6 %) determinations for <math> <mrow><msub><mi>C</mi> <mo>min⁡</mo></msub> </mrow> </math> thresholds of <math><mrow><mo>≥</mo> <mn>8</mn></mrow> </math> mg L^-1 and <math><mrow><mo>≥</mo> <mn>4</mn></mrow> </math> mg L^-1, respectively. Efficacy improved when considering only determinations at the correct timing. A total of 18 (54.5 %) patients are still in treatment, while 11 (33.3 %) completed therapy with clinical success. Three patients experienced a relapse after the end of the treatment, while one patient experienced failure, and no adverse events were reported. <b>Conclusions</b>: Dalbavancin is a viable option for prolonged OAI management when other therapies are unavailable or high-risk. Proactive TDM effectively supports this approach by ensuring adequate drug exposure while preventing accumulation.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"10 4","pages":"255-263"},"PeriodicalIF":2.8,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12311387/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144760226","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"One-stage knee replacement shows similar healing rates in patients with negative or positive preoperative cultures: a retrospective cohort study.","authors":"Marta Sabater-Martos, Laura Morata, Josep Maria Segur, Alex Soriano, Juan Carlos Martínez-Pastor","doi":"10.5194/jbji-10-237-2025","DOIUrl":"https://doi.org/10.5194/jbji-10-237-2025","url":null,"abstract":"<p><p><b>Introduction</b>: Treatment of chronic periprosthetic joint infections (PJIs) involves prosthesis removal, reimplantation, and antibiotic treatment. This process can be performed as a two-stage replacement or a one-stage replacement. One-stage replacement is classically performed only in patients who meet very strict criteria. The objective of this study was to analyse the healing and failure rates of one-stage knee replacement in patients with positive preoperative cultures and in those with negative preoperative cultures. Secondarily, we analysed the healing rate in patients with a sinus tract. <b>Material and methods</b>: We included 56 patients diagnosed with likely or confirmed PJI who underwent one-stage knee replacement in our centre between January 2016 and December 2021, with a minimum follow-up of 1 year. We evaluated the differences between cases with positive and negative preoperative cultures. Survival differences were assessed according to preoperative culture positivity and the presence of a sinus tract. <b>Results</b>: Preoperative cultures had positive results in 43 patients (76.8 %) and negative results in 13 patients (23.2 %). The overall failure rate was 12.5 % (seven patients), with one of these patients having had negative preoperative cultures. Of the 49 patients (87.5 %) with good results, 12 had negative preoperative cultures, and 37 had positive cultures ( <math><mrow><mi>p</mi> <mo>=</mo> <mn>1.00</mn></mrow> </math> ). Only 6 (10.7 %) of the 56 patients studied presented with a sinus tract. The differences in terms of healing and failure rates between patients with and without a sinus tract were not statistically significant ( <math><mrow><mi>p</mi> <mo>=</mo> <mn>0.57</mn></mrow> </math> ). <b>Discussion</b>: Using less strict criteria for patients, such as allowing preoperative negative cultures or the presence of a sinus tract, produced similar results to those for patients with only positive cultures or intact soft tissue.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"10 4","pages":"237-241"},"PeriodicalIF":2.8,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12311388/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144760225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Type of acute periprosthetic joint infection may not affect failure of debridement, antibiotics, and implant retention after total knee arthroplasty.","authors":"Andrew J Frear, Michael F Shannon, Shaan Sadhwani, Anthony O Kamson, Clair Smith, Charity G Patterson, Victoria R Wong, Frank Johannes Plate, Kenneth L Urish","doi":"10.5194/jbji-10-225-2025","DOIUrl":"https://doi.org/10.5194/jbji-10-225-2025","url":null,"abstract":"<p><p><b>Introduction:</b> In periprosthetic joint infection (PJI) following total knee arthroplasty (TKA), debridement, antibiotics, and implant retention (DAIR) is a common procedure with a high rate of failure. Timing of infection can be used to stratify acute PJI into acute postoperative, intermediate, and hematogenous infections. Potential differences in prognosis between classifications remain unclear. This investigation assessed the current overall failure of DAIR procedures, compared DAIR failure between three types of acute PJI, and analyzed DAIR outcomes in an \"optimal\" cohort of patients with a minimal number of medical comorbidities. <b>Methods:</b> This retrospective study compared 122 patients with acute TKA PJI who underwent DAIR between 2016 and 2022. Categorization was based on timing between index TKA and PJI diagnosis, with <math><mo><</mo></math> 6 weeks termed postoperative ( <math><mrow><mi>n</mi> <mo>=</mo></mrow> </math> 43), 6 weeks to 1 year termed intermediate ( <math><mrow><mi>n</mi> <mo>=</mo></mrow> </math> 19), and <math><mo>></mo></math> 1 year termed hematogenous ( <math><mrow><mi>n</mi> <mo>=</mo></mrow> </math> 60). The primary outcome was DAIR failure, defined as reoperation for PJI. Subgroup analysis was performed after removing patients with high-risk comorbidities. <b>Results:</b> The overall failure rate was 42 %; 78.4 % of failures occurred within 1 year. No significant differences in the failure rate were found between PJI types at any time point. At 1 year, 58 % postoperative, 58 % intermediate, and 77 % hematogenous cases remained failure-free ( <math><mrow><mi>p</mi> <mo>=</mo></mrow> </math> 0.09). Failure rates of 45 % postoperative, 44 % intermediate, and 36 % hematogenous cases were seen in the optimal cohort, without significant differences. <b>Conclusions:</b> DAIR failure for acute TKA PJI is high. Although no differences in failure rates were observed based on the PJI type, DAIR failure trended lower for the hematogenous group in this study. Outcomes for DAIR appear similar regardless of the PJI type in optimal patients.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"10 4","pages":"225-235"},"PeriodicalIF":2.8,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12311389/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144760235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk factors for treatment failure in late acute periprosthetic joint infection in patients with rheumatoid arthritis treated with surgical debridement - a case-control study.","authors":"Hendrika M Schenk, Marine Sebillotte, Jose Lomas, Adrian Taylor, Eva Benavent, Oscar Murillo, Marta Fernandez-Sampedro, Kaisa Huotari, Craig Aboltins, Rihard Trebse, Alex Soriano, Marjan Wouthuyzen-Bakker","doi":"10.5194/jbji-10-217-2025","DOIUrl":"10.5194/jbji-10-217-2025","url":null,"abstract":"<p><p><b>Background</b>: Patients with rheumatoid arthritis (RA) with late acute periprosthetic joint infections (PJIs) treated with surgical debridement, antibiotics, and implant retention (DAIR) have a high failure rate. We conducted a case-control study to identify risk factors for DAIR failure in this specific patient population. <b>Methods</b>: Data from an international multicenter retrospective observational study were used. Late acute PJI was defined as a sudden and acute onset of PJI symptoms occurring more than 3 months after implantation in a previously asymptomatic joint. Cases with RA were matched with cases without RA based on the affected joint. A multivariate Cox regression, stratified for RA, was used to identify risk factors and calculate hazard ratios (HRs) for failure. Subgroup analysis was done to explore the role of immunosuppressive therapy. <b>Results</b>: A total of 40 patients with RA and 80 control patients without RA were included. The use or continuation of immunosuppressive drugs was not associated with a higher failure rate. No significant association was found between the duration of symptoms, causative microorganisms, and therapy failure. Bacteremia was an independent predictor for treatment failure (HR of 1.972; 95 % confidence interval, CI, of 1.088-3.573; <math><mi>p</mi></math> <math><mo>=</mo></math> 0.025), and the exchange of modular components was associated with a lower risk of treatment failure (HR of 0.491; 95 % CI of 0.259-0.931; <math><mrow><mi>p</mi> <mo>=</mo> <mn>0.029</mn></mrow> </math> ). <b>Conclusion</b>: In patients with RA and a late acute PJI treated with DAIR, bacteremia is an important predictor of treatment failure. Exchanging the modular components seems to be especially important in this patient group and is associated with a lower failure rate.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"10 4","pages":"217-224"},"PeriodicalIF":1.8,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12272950/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144674838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The value of repeated debridement, antibiotics, and implant retention (DAIR) for early periprosthetic joint infection.","authors":"Ruben Scholten, Gerjon Hannink, Matthijs P Somford, Job L C van Susante","doi":"10.5194/jbji-10-207-2025","DOIUrl":"10.5194/jbji-10-207-2025","url":null,"abstract":"<p><p><b>Background and purpose</b>: Debridement, antibiotics, and implant retention (DAIR) is the proposed initial treatment of early periprosthetic joint infection (PJI), but it may fail to provide infection control. Subsequently, either implant removal or repeated DAIR may be considered. This study aims to identify the failure rate of repeated DAIR for early PJI in primary total knee arthroplasty (TKA) and total hip arthroplasty (THA). <b>Methods:</b> All DAIRs performed following primary THA or TKA for early PJI from 2010 to 2019 were retrospectively analysed. Patient demographics, comorbidities, surgical details, and pre-DAIR C-reactive protein (CRP) levels were recorded. Failure of early infection control (within 1 month after DAIR) prompted a second DAIR. Follow-up was performed up to 2 years post-surgery. A Kaplan-Meier survival analysis was performed in single- and repeated-DAIR groups. Cox regression analyses explored potential risk factors for implant failure after repeated DAIR. <b>Results:</b> A total of 124 cases of early PJI were included. Single DAIR achieved adequate infection control in 69.4 % ( <math><mrow><mi>n</mi> <mo>=</mo> <mn>86</mn></mrow> </math> ) of cases, while 30.6 % ( <math><mrow><mi>n</mi> <mo>=</mo> <mn>38</mn></mrow> </math> ) of cases underwent repeated DAIR within 3-23 d. After 2 years, implant removal was performed in 8 cases (9.9 %; 95 %CI 3.0 %-16.0 %) in the single-DAIR group and in 8 cases (22.2 %; 95 %CI 7.3 %-34.7 %) in the repeated-DAIR group. No statistically significant associations between the failure of repeated DAIR and its potential risk factors were found. <b>Conclusion:</b> If initial DAIR does not achieve early PJI control, repeated DAIR can still be considered, as it may avoid implant removal in 77.8 % of cases. The authors advocate for tailored decisions considering implant revisability, patient comorbidity, and pathogen susceptibility.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"10 4","pages":"207-215"},"PeriodicalIF":1.8,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12246790/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144626492","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CLOSE-UP - a favourable protocol for limb-sparing surgery of diabetic foot osteomyelitis.","authors":"Anton Alexander Nolte Peterlin, Louise Kruse Jensen, Emil Gleipner-Andersen, Hans Gottlieb","doi":"10.5194/jbji-10-199-2025","DOIUrl":"10.5194/jbji-10-199-2025","url":null,"abstract":"<p><p><b>Introduction</b>: Diabetic foot osteomyelitis (DFO) is a severe complication of diabetic foot ulcers, leading to high morbidity, mortality, and major limb amputation risk. While limb-sparing surgery is well established, optimal wound closure and intraosseous antibiotic strategies remain under-explored and under-reported. This study evaluates a single-stage limb-sparing surgical approach incorporating primary closure and local intraosseous antibiotic therapy. <b>Methods</b>: This retrospective study included 97 DFO patients (2017-2024) treated using the CLOSE-UP (Conservative surgery, Local antibiotics, Oral versus intravenous antibiotics - OVIVA, Samples, Effective limb preservation, and closUre Primary) protocol, developed to standardize DFO surgery. The one-stage procedure involved bone sampling, local debridement or minor amputation (distal to the tarsometatarsal joint), antibiotic-loaded calcium sulfate-hydroxyapatite biocomposite application, and primary wound closure. Postoperatively, patients followed the OVIVA antimicrobial protocol: 1 week of intravenous (IV) therapy and 5 weeks of oral (empiric penicillin-cloxacillin) therapy. The primary outcome was treatment failure within 1 year, with a minimum follow-up of 12 months. <b>Results</b>: Clinical failure occurred in 13 patients (13.4 %), with only 4 patients (4.1 %) requiring major amputation. Peripheral arterial disease was present in 24 patients (24.7 %) and was the only variable significantly associated with clinical failure (odds ratios: 10.21; <math><mrow><mi>P</mi> <mo><</mo> <mn>0.01</mn></mrow> </math> ). The 1-year and 3-year mortality rates were 14.4 % and 35.9 %, respectively. <b>Conclusions</b>: The CLOSE-UP protocol demonstrated favourable outcomes. Given the high risk of mortality and limb loss in DFO, this structured approach has the potential to improve mobility, shorten rehabilitation, lower costs, and enhance quality of life. Further research, particularly randomized controlled trials, should focus on optimizing wound closure to improve long-term limb preservation and survival.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"10 3","pages":"199-206"},"PeriodicalIF":1.8,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12177510/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144333230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Shoulder paralysis as a presentation of septic arthritis with intramuscular scapular abscess - a case report.","authors":"Ana Rita Senra, João Pedro Vieira, Pedro Negrão, Nuno Neves, Carlos Maia Dias, Maria João Leite, Manuel Ribeiro Silva","doi":"10.5194/jbji-10-193-2025","DOIUrl":"10.5194/jbji-10-193-2025","url":null,"abstract":"<p><p>We present a 31-year-old immunocompromised woman with shoulder septic arthritis and an infraspinatus abscess presenting with paralysis secondary to axillary neuropathy after an intra-articular injection. At 12 months, mobility and normal functioning were restored. This first reported adult case highlights the need for high suspicion of septic arthritis in immunocompromised patients and emphasizes effective management strategies.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"10 3","pages":"193-197"},"PeriodicalIF":1.8,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12163723/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144302177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"One- versus two-stage septic hip and knee revision surgery: a comparative cohort outcome study with short- to mid-term follow-up.","authors":"Michelle M J Jacobs, Petra J C Heesterbeek, Karin Veerman, Jon H M Goosen","doi":"10.5194/jbji-10-185-2025","DOIUrl":"10.5194/jbji-10-185-2025","url":null,"abstract":"<p><p><b>Introduction</b>: One-stage revisions seem to have similar reinfection rates compared to two-stage revisions for the treatment of periprosthetic joint infections based on retrospective cohort studies with a large variety of indications and treatment protocols. This study aimed to compare outcomes between comparable groups of one-stage and two-stage revision patients. <b>Materials and methods</b>: We performed a retrospective cohort study, where equal numbers of one-stage and two-stage patients (knee: <math><mrow><mi>n</mi> <mo>=</mo> <mn>24</mn></mrow> </math> ; hip: <math><mrow><mi>n</mi> <mo>=</mo> <mn>40</mn></mrow> </math> ) were randomly included with the same inclusion and exclusion criteria. Patient characteristics and infection-related outcomes at latest follow-up were obtained via chart review. Functional outcomes (knee: Knee Society Score (KSS), range of motion (ROM), and visual analogue scale (VAS) pain and satisfaction; hip: Oxford Hip Score (OHS), Hip Disability and Osteoarthritis Outcome Score-Physical Function Shortform (HOOS-PS), VAS pain and satisfaction, and European Quality of Life 5 Dimensions 3 Level version (EQ5D-3L)) preoperatively (hip only) and at 1-year follow-up were extracted from a revision database. Outcomes were compared between one- and two-stage groups and for knee and hip cases separately. <b>Results</b>: One- and two-stage groups were comparable for baseline characteristics. Reinfection occurred for both the knee and hip cohorts in one one-stage patient and one two-stage patient ( <math><mrow><mi>P</mi> <mo>=</mo> <mn>1.00</mn></mrow> </math> for both cohorts). More adverse events, of which two were spacer-related, were observed in two-stage hip patients ( <math><mrow><mi>n</mi> <mo>=</mo> <mn>7</mn></mrow> </math> ) compared to in one-stage patients ( <math><mrow><mi>n</mi> <mo>=</mo> <mn>2</mn></mrow> </math> ) ( <math><mrow><mi>P</mi> <mo>=</mo> <mn>0.13</mn></mrow> </math> ). Functional outcomes did not differ between one- and two-stage patients for both knee and hip cohorts. <b>Conclusions</b>: This study showed no differences in terms of reinfection rates and functional outcomes between comparable groups of one- and two-stage septic knee and hip revision patients. A trend towards more adverse events in two-stage hip patients was seen, which was partly due to spacer complications.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"10 3","pages":"185-192"},"PeriodicalIF":1.8,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12163721/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144302176","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Differential synovial fluid white blood cell count for the diagnosis of chronic peri-prosthetic joint infection - a systematic review and meta-analysis.","authors":"Marta Sabater-Martos, Martin Clauss, Ana Ribau, Ricardo Sousa, On Behalf Of The Leukocyte Count Synovial Fluid Working Group For The Unified Pji Definition Task Force","doi":"10.5194/jbji-10-165-2025","DOIUrl":"10.5194/jbji-10-165-2025","url":null,"abstract":"<p><p><b>Introduction</b>: Peri-prosthetic joint infection (PJI) is a significant complication of arthroplasty, lacking a single gold standard diagnostic test. Synovial fluid white blood cell (WBC) count and polymorphonuclear neutrophil (PMN) proportion are widely used diagnostic tools, but their optimal cutoffs remain unclear, particularly for chronic PJI. <b>Material and methods</b>: This systematic review and meta-analysis included 74 studies published between 2000 and 2024. Data on diagnostic performance (sensitivity, specificity, and diagnostic odds ratios - DORs) of WBC count and PMN proportions were analysed. Sub-group analyses and heterogeneity assessments were performed, and optimal cutoffs for diagnostic accuracy were identified. <b>Results</b>: The meta-analysis revealed a WBC count summary DOR of 58.38 (95 % CI - confidence interval: 48.48-70.32) with an area under the curve (AUC) of the summarized receiver operating characteristic curve of 0.952. The PMN proportion showed a DOR of 43.17 (95 % CI: 35.31-52.79) and an AUC of 0.941. Optimal diagnostic thresholds for chronic PJI were WBC count <math><mo>></mo></math> 2600 cells per microlitre and PMN <math><mo>></mo></math> 70 %. Rule-in thresholds (specificity <math><mrow><mo>></mo> <mn>95</mn></mrow> </math> %) were WBC count <math><mo>≥</mo></math> 3000 cells per microlitre and PMN <math><mo>≥</mo></math> 75 %, while rule-out thresholds (sensitivity <math><mo>></mo></math> 95 %) were WBC count <math><mo>≤</mo></math> 1500 cells per microlitre and PMN <math><mo>≤</mo></math> 65 %. Confounding conditions such as fractures, inflammatory arthritis, and metal-related reactions reduced test accuracy. <b>Conclusions</b>: Synovial fluid analysis remains a critical diagnostic tool for chronic PJI. Thresholds of WBC count <math><mo><</mo></math> 1500 and <math><mrow><mo>></mo> <mn>3000</mn></mrow> </math>  cells per microlitre and PMN <math><mo><</mo></math> 65 % and <math><mrow><mo>></mo> <mn>75</mn></mrow> </math> % provide reliable negative and positive predictive values. A standardized diagnostic framework is essential for addressing remaining controversies and ensuring consistent interpretation across clinical settings.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"10 3","pages":"165-184"},"PeriodicalIF":1.8,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12082335/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144093826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}