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Clinical Infectious Diseases : An... Mar 2024Native joint septic arthritis (NJSA) is definitively diagnosed by a positive Gram stain or culture, along with supportive clinical findings. Preoperative antibiotics are...
BACKGROUND
Native joint septic arthritis (NJSA) is definitively diagnosed by a positive Gram stain or culture, along with supportive clinical findings. Preoperative antibiotics are known to alter synovial fluid cell count, Gram stain and culture results and are typically postponed until after arthrocentesis to optimize diagnostic accuracy. However, data on the impact of preoperative antibiotics on operative culture yield for NJSA diagnosis are limited.
METHODS
We retrospectively reviewed adult cases of NJSA who underwent surgery at Mayo Clinic facilities from 2012-2021 to analyze the effect of preoperative antibiotics on operative culture yield through a paired analysis of preoperative culture (POC) and operative culture (OC) results using logistic regression and generalized estimating equations.
RESULTS
Two hundred ninety-nine patients with NJSA affecting 321 joints were included. Among those receiving preoperative antibiotics, yield significantly decreased from 68.0% at POC to 57.1% at OC (p < .001). In contrast, for patients without preoperative antibiotics there was a non-significant increase in yield from 60.9% at POC to 67.4% at OC (p = 0.244). In a logistic regression model for paired data, preoperative antibiotic exposure was more likely to decrease OC yield compared to non-exposure (OR = 2.12; 95% CI = 1.24-3.64; p = .006). Within the preoperative antibiotic group, additional antibiotic doses and earlier antibiotic initiation were associated with lower OC yield.
CONCLUSION
In patients with NJSA, preoperative antibiotic exposure resulted in a significant decrease in microbiologic yield of operative cultures as compared to patients in whom antibiotic therapy was held prior to obtaining operative cultures.
PubMed: 38466824
DOI: 10.1093/cid/ciae136 -
Anatomia, Histologia, Embryologia Mar 2024Joint effusion is diagnostically important. The canine carpal joint effusion, which is sometimes difficult to detect clinically, has received less attention in...
Joint effusion is diagnostically important. The canine carpal joint effusion, which is sometimes difficult to detect clinically, has received less attention in diagnostic ultrasound (US) studies. The aim of the present study was to provide a description of the morphological appearance of the canine carpal joint cavities and recesses using US, radiography, helical computed tomography (CT) and three-dimensional volume rendering technique (3D-VRT) images and to prove the applicability of musculoskeletal US for the detection of artificial carpal joint effusion in dogs. The understanding of the characteristics of these structures in normal patients is essential in the diagnosis. Twenty-eight clinically and radiologically unremarkable canine carpal cadavers of different breeds were examined, representative images were selected and anatomical structures were labelled. The canine carpal joint cavities and in particular its recesses had a complex appearance with a basic structure found in all dogs: Antebrachiocarpal joint: dorsoproximal antebrachiocarpal recess, dorsodistal antebrachiocarpal recess, medial antebrachiocarpal recess, lateral antebrachiocarpal recess and five palmar antebrachiocarpal recesses. Middle carpal joint: two dorsal middle carpal recesses, medial common middle carpal and carpometacarpal recess, lateral common middle carpal and carpometacarpal recess, four palmar middle carpal recesses. The carpometacarpal joint had dorsal and palmar funnel-shaped and irregular, finely tubular extensions, the most prominent ran dorsal to metacarpal III, the maximum distal end represented the proximal metacarpal diaphysis. All recesses presented ultrasonographically as a generalized anechogenic to hypoechoic filled continuation of the articular capsule with an indistinct peripheral hypoechogenic to isoechogenic fine capsule, the synovial-connective tissue interface was difficult to identify. The novel results of this study provide the first morphological description of the ultrasonographic, radiographic and computed tomographic arthrographic appearance of the canine carpal joint cavities and recesses with different injection volumes. The canine carpal joint cavities and in particular its recesses had a complex appearance with a basic structure found in all dogs. The applicability of musculoskeletal US to visualize an artificial carpal effusion has been demonstrated. The results of this study, and in particular US, give the practitioner an advantage in visualizing joint effusion and assist in the decision to perform arthrocentesis.
Topics: Dogs; Animals; Carpal Joints; Arthrography; Radiography; Tomography, X-Ray Computed; Joint Capsule
PubMed: 38462761
DOI: 10.1111/ahe.13026 -
The British Journal of Oral &... Apr 2024Management of temporomandibular disorders (TMD) follows a stepwise approach of conservative management, minimally invasive surgery (arthrocentesis and arthroscopy), open...
Management of temporomandibular disorders (TMD) follows a stepwise approach of conservative management, minimally invasive surgery (arthrocentesis and arthroscopy), open surgery and alloplastic replacement. The majority of patients treated in primary care and managed initially in secondary care have myofascial pain and can be managed conservatively with rest, topical NSAIDs, muscle massage, and a bite orthosis. Those who fail to improve and have articular related pain with limitation of function should initially undergo arthroscopic investigation and arthrocentesis, which is effective at resolving symptoms in 80% of patients. Arthroscopy provides the best diagnostic aid should there be a failure to improve and should enable the surgeon to appropriately plan open surgery. Historically, surgical intervention was based on a 'one size fits all' philosophy with the surgeon carrying out a procedure which they are used to doing regardless of the pathology. Prior to arthroscopy this carried an '80% chance of getting 80% better' regardless of approach. Prior arthroscopy reduced success rates to 50%-60% and a better success rate is needed. Basing surgical intervention on the pathology encountered is a sensible approach to joint management, with the surgeon performing surgery on the articular surfaces or disc as indicated. Having used this approach over the last 15 years the author has achieved success rates of 80% in the longer term and this philosophy, rationale, and technique will be discussed along with analysis of more recent publications in the field.
Topics: Humans; Arthrocentesis; Arthroplasty, Replacement; Arthroscopy; Temporomandibular Joint Disorders
PubMed: 38453560
DOI: 10.1016/j.bjoms.2024.01.006 -
The Pediatric Infectious Disease Journal Jul 2024Acute bacterial arthritis (ABA) is a serious, pediatric infection that can result in motor comorbidities. Normally, a joint fluid white blood cell (WBC) count of 50,000...
BACKGROUND
Acute bacterial arthritis (ABA) is a serious, pediatric infection that can result in motor comorbidities. Normally, a joint fluid white blood cell (WBC) count of 50,000 or more cells/mm 3 is used to make a presumptive diagnosis of ABA. This study evaluated the utility of the joint fluid WBC count for diagnosing pediatric ABA confirmed by a positive culture result.
METHODS
Patients with ABA between March 2010 and March 2023 at Tokyo Metropolitan Children's Medical Center were included. ABA was confirmed by positive joint fluid culture results for a pathogenic organism. Patients with negative results and those without a joint fluid WBC count were excluded. Electronic medical records were retrospectively reviewed for demographic data, timing of arthrocentesis, culture results and the joint fluid WBC count.
RESULTS
Ninety-five patients with ABA were identified; of these, 22 were included. The median age was 5 years [interquartile range (IQR): 2-10 years]. Males comprised 55% of the population. The median joint fluid WBC count was 19,575 (IQR: 6806-47,388) cells/mm 3 , and 23% of the patients had 50,000 cells/mm 3 or more. The median time from symptom onset to arthrocentesis was 3 days (IQR: 2-5 days). The isolated organisms were methicillin-susceptible Staphylococcus aureus (50%), methicillin-resistant S. aureus (9%), Streptococcus pyogenes (27%), Streptococcus pneumoniae (5%), Klebsiella pneumoniae (5%) and Salmonella spp. (5%).
CONCLUSIONS
Most of the patients with ABA confirmed by positive results of a joint fluid culture had a joint fluid WBC count of less than 50,000 cells/mm 3 .
Topics: Humans; Male; Female; Child; Arthritis, Infectious; Child, Preschool; Retrospective Studies; Synovial Fluid; Leukocyte Count; Bacteria; Acute Disease; Arthrocentesis
PubMed: 38451922
DOI: 10.1097/INF.0000000000004311 -
The Journal of International Medical... Feb 2024Periprosthetic hip infection caused by is rare and only a few cases have been reported. This current case report presents a case of a man in his early 50s who developed... (Review)
Review
Periprosthetic hip infection caused by is rare and only a few cases have been reported. This current case report presents a case of a man in his early 50s who developed periprosthetic hip infection 2 years after right hip arthroplasty. There was no fever or pain, the usual cardinal signs of infection, except for a sinus tract at the previous surgical incision. Laboratory and arthrocentesis culture examinations (done twice) confirmed infection with . Accordingly, a two-stage revision surgery was performed accompanied by antibiotic treatment with doxycycline and rifampicin after each stage. There was no recurrence at the 2-year follow-up, with good functional recovery of the hip joint. Clinically, this case serves to highlight the fact that periprosthetic hip infections caused by might not present with the typical symptoms such as fever or hip pain. Furthermore, this current case involved a chronic sinus tract, so the diagnostic and therapeutic course of this case offers useful insights for managing similar cases in the future. In addition, a review of the literature on the diagnosis and treatment of -caused periprosthetic hip infection is presented.
Topics: Humans; Male; Anti-Bacterial Agents; Arthroplasty, Replacement, Hip; Brucella; Brucellosis; Pain; Middle Aged
PubMed: 38422032
DOI: 10.1177/03000605241234050 -
The Orthopedic Clinics of North America Apr 2024Septic arthritis of the wrist can have severe deleterious effects on cartilage and bone if not promptly addressed. Expedient diagnosis and early medical intervention are... (Review)
Review
Septic arthritis of the wrist can have severe deleterious effects on cartilage and bone if not promptly addressed. Expedient diagnosis and early medical intervention are important. The most effective strategy involves immediate arthrocentesis of the infected joint, enabling precise antibiotic selection based on joint fluid analysis. Diagnostic imaging is important in excluding fractures and identifying abscesses. This review explores the etiologic factors underlying septic wrist joint, identifying risk factors, and delineating optimal diagnosis and treatment approaches. The overarching goal is to impart valuable insights and guidance in the management of septic wrist joint, ensuring the highest quality patient care and optimal clinical outcomes.
Topics: Humans; Arthritis, Infectious; Debridement; Risk Factors; Wrist; Wrist Joint
PubMed: 38403373
DOI: 10.1016/j.ocl.2023.11.002 -
Journal of Oral Rehabilitation Jun 2024Surgical treatment of temporomandibular joint (TMJ) disc displacement (DD) has been established in different forms since over a century. Ther is a consensus to perform... (Review)
Review
BACKGROUND
Surgical treatment of temporomandibular joint (TMJ) disc displacement (DD) has been established in different forms since over a century. Ther is a consensus to perform minimal invasive interventions as first-line surgical treatment since there are no evidence on best surgical practice yet.
OBJECTIVE
The aim was to perform a complex systematic review (SR) on the topic-is there evidence for surgical treatment of TMJ DD?
METHODS
The PICO was defined as DD patients (population), treated with different surgical interventions including arthrocentesis (intervention), compared with other or no treatment (control) regarding the outcome variables mandibular function, mouth opening capacity, TMJ pain, etcetera (outcome). For identification of prospective controlled trials and SRs, a search strategy was developed for application in three databases.
RESULTS
The search yielded 4931 studies of which 56 fulfilled the stipulated PICO. Studies with low or moderate risk of bias were possible to include in meta-analyses. There were evidence suggesting arthrocentesis being more effective compared to conservative management (maximum interincisal opening (MIO): p < .0001, I = 22%; TMJ pain: p = .0003, I = 84%) and arthrocentesis being slightly more effective than arthrocentesis with an adjunctive hyaluronic acid injection (MIO: p = .04, I = 0%; TMJ pain: p = .28, I = 0%). Other treatment comparisons showed nonsignificant differences. The performed meta-analyses only included 2-4 studies each, which might indicate a low grade of evidence.
CONCLUSION
Although arthrocentesis performed better than conservative management the findings should be interpreted cautiously, and non-invasive management considered as primary measure. Still, several knowledge gaps concerning surgical methods of choice remains.
Topics: Humans; Temporomandibular Joint Disorders; Minimally Invasive Surgical Procedures; Joint Dislocations; Temporomandibular Joint Disc; Treatment Outcome; Arthrocentesis; Range of Motion, Articular; Hyaluronic Acid; Injections, Intra-Articular
PubMed: 38400536
DOI: 10.1111/joor.13661 -
International Journal of Oral and... Jul 2024There is currently no consensus on the best treatment for painful temporomandibular disc displacement without reduction (DDwoR), and no network meta-analysis (NMA) of... (Meta-Analysis)
Meta-Analysis Review
There is currently no consensus on the best treatment for painful temporomandibular disc displacement without reduction (DDwoR), and no network meta-analysis (NMA) of randomized clinical trials (RCTs) comparing all types of treatments for this condition has been conducted. The objective of this study was to compare and rank all treatments for DDwoR, including conservative treatments, occlusal splints, low-level laser therapy (LLLT), arthrocentesis (Arthro) alone, Arthro plus intra-articular injection (IAI) of platelet-rich plasma (PRP), Arthro plus IAI of hyaluronic acid (HA), Arthro with exercises, Arthro plus occlusal splints, and manipulative therapy. Outcome variables were pain intensity on a visual analogue scale (VAS) and maximum mouth opening (MMO, mm). The mean difference with 95% confidence interval was estimated using Stata software. The GRADE system was used to assess the certainty of the evidence. A total of 742 patients from 16 RCTs were included in the NMA. Both direct meta-analysis and NMA showed that Arthro with IAI of co-adjuvants provided better pain reduction in the short term (≤3 months) than Arthro alone. However, the quality of the evidence was very low. In the intermediate term, Arthro alone or combined with co-adjuvants provided better pain reduction than conservative treatment, but with low-quality evidence. Conservative treatment significantly increased MMO in the short term compared to other treatments. In conclusion, the results of this NMA suggest that arthrocentesis with intra-articular injection of adjuvant medications may be superior to conservative treatments in reducing pain intensity at long-term follow-up, while no significant differences were found for the MMO outcome. However, the quality of evidence was generally low to very low, and further RCTs are needed to confirm these findings.
Topics: Humans; Randomized Controlled Trials as Topic; Network Meta-Analysis; Temporomandibular Joint Disorders; Pain Measurement; Injections, Intra-Articular; Arthrocentesis; Platelet-Rich Plasma; Hyaluronic Acid; Low-Level Light Therapy; Occlusal Splints; Joint Dislocations; Temporomandibular Joint Disc; Facial Pain; Combined Modality Therapy
PubMed: 38395688
DOI: 10.1016/j.ijom.2024.02.004 -
Bioengineering (Basel, Switzerland) Feb 2024Temporomandibular joint (TMJ) osteoarthritis is a degenerative disease of the TMJ. It is characterized by progressive degradation of the extracellular matrix components...
INTRODUCTION
Temporomandibular joint (TMJ) osteoarthritis is a degenerative disease of the TMJ. It is characterized by progressive degradation of the extracellular matrix components of articular cartilage, with secondary inflammatory components leading to pain in the temporomandibular region and reduced mouth opening. Current treatments do not halt disease progression, hence the need for new therapies to reduce inflammation and, consequently, improve symptoms. The aim of our randomized controlled clinical trial protocol is to investigate the efficacy of adjuvant intra-articular injections of autologous tissue-like stromal vascular fraction (tSVF), compared to arthrocentesis alone, in reducing pain and improving mouth opening in TMJ osteoarthritis patients.
MATERIALS AND METHODS
The primary endpoint analysis will consist of the visual analogue scale (VAS) for pain. The secondary endpoint analyses will include maximal interincisal mouth opening measurements; assessment of oral health and mandibular function based on the oral health impact profile (OHIP) questionnaire and mandibular functional impairment questionnaire (MFIQ); complications during the follow up; synovial cytokine analysis at baseline and after 26 weeks; and nucleated cells and tSVF (immuno)histochemistry analyses of the intervention group.
DISCUSSION
Our randomized clinical trial protocol will be applied to evaluate the efficacy of a new promising tSVF injection therapy for TMJ osteoarthritis. The safety of intra-articular injections of tSVF has been proven for knee osteoarthritis. However, since a tSVF injection is considered a heterologous application of cell therapy, the regulatory requirements are strict, which makes medical ethical approval challenging.
PubMed: 38391657
DOI: 10.3390/bioengineering11020171