The direction of increasing effectiveness of the treatment of periprosthetic joint infection

Introduction: in the world orthopaedic practice, attention is increasingly paid to surgical interventions that improve the patient’s quality of life. One of these interventions is joint arthroplasty. The most common reason for this operation is osteoarthritis. It is known that coxarthrosis and gonarthrosis have a a high incidence in the world and there is a dynamic increase in the amount data pathologies. However, behind all the advantages of joint arthroplasty here is most formidable complication – periprosthetic infection, which can be fatal for the patient. According to opinion of domestic and foreign experts, for a successful treatment of patients with this complication, intervention is needed by specialists of a narrow profile in combination with a multidisciplinary approach, however patient routing an unresolved problem to this day.

The purpose of the work: to propose a model for routing patients with periprosthetic joint infection in Moscow.

Results. As a result of the work carried out it was found that the main problem of routing patients with periprosthetic joint infection in Moscow is the stage and timing of the disease. Often the patient with lat periprosthetin infection is hospitalized in a hospital in a city that has a department of purulent surgery, but the specialists of the department have not the necessary equipment and skills to provide effective and qualified care as a result of which patient wastes time that could be spent more rationally.

Conclusion. For more efficient routing of patients with periprosthetic joint infection in Moscow it is necessary to create specialized centres for the treatment of advanced perprosthetic infection. In cases of early periprosthetic infection the patient can undergo sanitizing surgical mixing in the conditions of the department of purulent surgery of any hospital in Moscow.

1. 1 Vina E.R., Kwoh C.K. Epidemiology of osteoarthritis: literature update. Curr Opin Rheumatol. 2018 Mar;30(2):160–167.

2. 2 Gubin A.V., Khan N.V., Ryabykh S.O., Ovchinnikov E.N., Burtsev A.V., Vetrile M.S. et al. "3DT" concept as a model of integration of traumatological and orthopedic service in priority areas of development and national projects of the Russian Federation. The genius of orthopedics. 2021;2:146–152. (In Russ).

3. 3 Traumatism, orthopedic morbidity, the state of traumatological and orthopedic care to the population in 2019. Moscow: N.N. Priorov National Medical Research Center of Traumatology and Orthopedics. 2020:165. (In Russ).

4. 4 Materials of the state statistical reporting of the Ministry of Health of the Russian Federation. URL: https://mednet.ru/miac/meditsinskaya-statistika (In Russ).

5. 5 Adeli B., Parvizi J. Strategies for the prevention of periprosthetic joint infection. J Bone Joint Surg Br. 2012 Nov;94(11 Suppl A):42–46. https://doi.org/10.1302/0301-620X.94B11.30833

6. 6 Zmistowski B., Parvizi J. Identification and treatment of infected total hip arthroplasty. Expert Rev Anti Infect Ther. 2012 Apr;10(4):509–518. https://doi.org/10.1586/eri.12.19

7. 7 Aggarwal V.K., Rasouli M.R., Parvizi J. Periprosthetic joint infection: Current concept. Indian J Orthop. 2013 Jan;47(1):10–17. https://doi.org/10.4103/0019-5413.106884

8. 8 Sukeik M., Haddad F.S. Two-stage procedure in the treatment of late chronic hip infections – spacer implantation. Int J Med Sci. 2009;6(5):253–257.

9. 9 Kuiper J.W., Willink R.T., Moojen D.J., van den Bekerom M.P., Colen S. Treatment of acute periprosthetic infections with prosthesis retention: Review of current concepts. World J Orthop. 2014 Nov 18;5(5):667–676. https://doi.org/10.5312/wjo.v5.i5.667. eCollection 2014.

10. 10 Shuman E.K., Urquhart A., Malani P.N. Management and prevention of prosthetic joint infection. Infect Dis Clin North Am. 2012 Mar;26(1):29– 39. https://doi.org/10.1016/j.idc.2011.09.011

11. 11 Yan C.H., Arciola C.R., Soriano A., Levin L.S., Bauer T.W., Parvizi J. Team Approach: The Management of Infection After Total Knee Replacement. JBJS Rev. 2018;6(4): e9. https://doi.org/10.2106/JBJS.RVW.17.00058

12. 12 Yacovelli S., Parvizi J. Who Should Manage Periprosthetic Joint Infection? The Case for a Multidisciplinary Approach. Travmatologiya i ortopediya Rossii [Traumatology and orthopedics of Russia]. 2019;25(4):28–32. https://doi.org/10.21823/2311-2905-2019-25-4-28-32

13. 13 Morrison T.A., Figgie M., Miller A.O., Goodman S.M. Periprosthetic joint infection in patients with inflammatory joint disease: a review of risk factors and current approaches to diagnosis and management. HSS J. 2013 Jul;9(2):183–194. https://doi.org/10.1007/s11420-013-9338-8 Epub 2013 Jul 3

14. 14 Sereda AP, Kochish AA, Cherny AA, et al. Epidemiology of hip and knee arthroplasty and periprosthetic infection in the Russian Federation. Traumatology and Orthopedics of Russia. 2021;27(3):84–93. (In Russ).

15. 15 Sankar S., Crudden J., Meisel H.J. Examining the in-vitro antimicrobial and in-vivo anti-biofilm efficacy of a PEEK-silver zeolite composite in tackling surgical site spine infections. EBJIS 2014; abstract F072, P.80.

16. 16 Lindeque B., Hartman Z., Noshchenko A., Cruse M. Infection after primary total hip arthroplasty. Orthopedics. 2014 Apr;37(4):257–265. 17 Frank R.M., Cross M.B., Della Valle C.J. Periprosthetic joint infection: modern aspects of prevention, diagnosis, and treatment. J KneeSurg. 2015 Apr;28(2):105–112. https://doi.org/10.1055/s-0034-1396015 Epub 2014 Nov 19.

17. 18 Yin J.M., Liu Z.T., Zhao S.C., Guo Y.J. Diagnosis, management, and prevention of prosthetic joint infections. Front Biosci (Landmark Ed). 2013 Jun 1;18:1349–57.

18. 19 Kurtz S.M., Ong K.L., Lau E., Bozic K.J., Berry D., Parvizi J. Prosthetic joint infection risk after TKA in the Medicare population. ClinOrthopRelat Res. 2010 Jan;468(1):52–56. https://doi.org/10.1007/s11999-009-1013-5 Epub 2009 Aug 8.

19. 20 Kuper M., Rosenstein A. Infection prevention in total knee and total hip arthroplasties. Am J Orthop (BelleMead NJ). 2008 Jan;37(1):E2-5.3.

20. 21 Rezapoor M., Parvizi J. Prevention of Periprosthetic Joint Infection. J Arthroplasty. 2015 Mar 18. pii: S0883-5403(15)00207-7. https://doi.org/10.1016/j.arth.2015.02.044. [Epub ahead of print]. Tande AJ, Patel R. Prosthetic joint infection. ClinMicrobiol Rev. 2014 Apr;27(2):302-45. https://doi.org/10.1128/CMR.00111-13

21. 22 Slobodskoy A.B., Osintsev E.Y., Lezhenev A.G. Complications after hip arthroplasty. Bulletin of Traumatology and Orthopedics named after N.N. Priorova. 2011;3:59–63. (In Russ)

22. 23 Sheraliev T.U., Fedorov E.A., Golnik V.N. Pavlov Periprosthetic infection in hip replacement: features of modern etiology, problems and prospects of diagnosis. Krasnoyarsk: Novosibirsk Scientific Research Institute of Traumatology and Orthopedics named after Ya. L. Tsivyan. 2021:230. (In Russ).

23. 24 Khon V.E., Zagorodny N.V., Zhadan A.V., Kuzmenko K.A., Tsiskarashvili A.V. The role of Girdlestone surgery in the treatment of infectious complications after hip replacement. Bulletin of Traumatology and Orthopedics named after N.N. Priorov. 2013;3:25–30. (In Russ)

24. 25 Tsukayama D.T., Estrada R., Gustilo R.B. Infection after total hip arthroplasty. A study of the treatment ofone hundred and six infections. J. Bone Joint Surg. Am. 1996;78:512–523.

25. 26 Ntalos D., Berger-Groch J., Rohde H., Grossterlinden L.G., Both A., Luebke A. et al. Implementation of a multidisciplinary infections conference affects the treatment plan in prosthetic joint infections of the hip: a retrospective study. Arch Orthop Trauma Surg. 2019;139(4):467–473. https://doi.org/10.1007/s00402-018-3079-6

26. 27 Anderson M.B., Arciola C.R., Sarvanan S.A., Campoccia D., Certain L., Diaz-Ledezma C. et al. General Assembly, Treatment, Multidisciplinary Issues: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty. 2019;34(2S):S239-S243. https://doi.org/10.1016/j.arth.2018.09.075.6

27. 28 Dietz M.J., Springer B.D., Barnes P.D., Falciglia M., Friedrich A.D., Berendt A.R. et al. Best practices for centers of excellence in addressing periprosthetic joint infection. J Am Acad Orthop Surg. 2015;23 Suppl:S12-7. https://doi.org/10.5435/JAAOS-D-14-00380

28. 29 Minassian A.M., Osmon D.R., Berendt A.R. Clinical guidelines in the management of prosthetic joint infection. J Antimicrob Chemother. 2014;69 Suppl 1:i29–35. https://doi.org/10.1093/jac/dku253

29. 30 Ibrahim M.S., Raja S., Khan M.A., Haddad F.S. A multidisciplinary team approach to two-stage revision for the infected hip replacement: a minimum five-year follow-up study. Bone Joint J. 2014;96-B(10):1312–318. https://doi.org/10.1302/0301-620X.96B10.32875

30. 31 Petretta R., Phillips J., Toms A. Management of acute periprosthetic joint infection of the knee – Algorithms for the on call surgeon. Surgeon. 2017;15(2):83–92. https://doi.org/10.1016/j.surge.2016.06.001

31. 32 Kheir M.M., Tan T.L., George J., Higuera C.A., Malten fort M.G., Parvizi J. Development and Evaluation of a Prognostic Calculator for the Surgical Treatment of Periprosthetic Joint Infection. J Arthroplasty. 2018;33(9):2986–2992.e1. https://doi.org/10.1016/j.arth.2018.04.034

32. 33 Jayakumar P., Moore M.L.G., Bozic K.J. Team Approach: A Multidisciplinary Approach to the Management of Hip and Knee Osteoarthritis. JBJS Rev. 2019;7(6):e10. https://doi.org/10.2106/jbjs.rvw.18.00133.15

33. 34 Akgün D., Müller M., Perka C., Winkler T. High cure rate of periprosthetic hip joint infection with multidisciplinary team approach using standardized two-stage exchange. J Orthop Surg Res. 2019;14(1):78. https://doi.org/10.1186/s13018-019-1122-0.16

34. 35 Matar H.E., Stritch P., Emms N. Two-stage revisions of infected hip replacements: Subspecialisation and patient-reported outcome measures. J Orthop. 2019;16(2):179–181. https://doi.org/10.1016/j.jor.2019.02.011.17

35. 36 Parvizi J., Shohat N., Gehrke T. Prevention of periprosthetic joint infection. Bone Joint J. 2017;99-B(4_Supple_B):3-10. https://doi.org/10.1302/0301-620x.99b4.bjj-2016-1212.r1