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Open Forum Infectious Diseases Jun 2024The risk of failure associated with different surgical strategies for prosthetic joint infections (PJIs) among patients with and without is uncertain. The purpose of...
BACKGROUND
The risk of failure associated with different surgical strategies for prosthetic joint infections (PJIs) among patients with and without is uncertain. The purpose of this study was to assess whether modifies the association between retained hardware and failure following revision surgery for PJI of the knee.
METHODS
This was a single-center retrospective cohort study of 106 first PJIs of the knee between 2016 and 2020 at a rural academic medical center. The exposure was retained hardware following revision surgery for PJI, and the outcomes were recurrent infection, any infection, and a composite outcome including any infection, unplanned revision, failure to undergo reimplantation, amputation, or death within 2 years of revision. We used negative binomial regression to quantify the association between the exposure and outcome and to assess the presence of as an effect modifier.
RESULTS
Retained hardware was significantly associated with failure when defined as recurrent infection among PJI (adjusted risk difference [aRD], 0.38; 95% CI, 0.12-0.64) but not in the absence of (aRD, -0.02; 95% CI, -0.17 to 0.13), and was an effect modifier ( = .01).
CONCLUSIONS
We report a significant association between the presence of retained hardware and recurrent infection among PJI of the knee, but not for non- PJI. This could help inform the surgical management of PJI of the knee in cases where the microbiology is known before surgery.
PubMed: 38919513
DOI: 10.1093/ofid/ofae306 -
Journal of Anaesthesiology, Clinical... 2024
PubMed: 38919446
DOI: 10.4103/joacp.joacp_394_22 -
The Iowa Orthopaedic Journal 2024Periprosthetic joint infection (PJI) in revision arthroplasty presents as a challenging complication that is difficult to manage. Debridement, antibiotics, and implant...
BACKGROUND
Periprosthetic joint infection (PJI) in revision arthroplasty presents as a challenging complication that is difficult to manage. Debridement, antibiotics, and implant retention (DAIR) is a recognized treatment option, although few studies have investigated success rates in addition to eventual amputation rates for failed cases.
METHODS
A retrospective review of 365 DAIR cases was performed at a single institution from 2008-2020. Patient records were thoroughly reviewed for inclusion and exclusion criteria by multiple members of the research team, discovering 45 cases met criteria for the study cohort. Demographic information, medical history, culture data, and surgical history, were recorded. DAIR's overall survivorship was evaluated with a Kaplan-Meier (KM) survival curve. Additional KM curves were constructed to compare acute postoperative versus acute hematogenous infections as well as DAIR survivorship relative to infecting organism.
RESULTS
DAIR's success rate in revision TKA was 77% at 0.5 years, 56% at 2 years and 46% at 5 years. No significant difference was noted in survivorship when comparing acute postoperative and acute hematogenous cases at 5 years (29 vs 51%, P=0.64). No significance differences in survivorship were noted according to infecting organism (P =0.30). Median follow up duration was significantly lower in the failed DAIR cohort with a median time of 0.5 years in comparison to 1.7 years for the successful DAIR group (P =0.012). There were 20 DAIR cases that failed, 10 of which resulted in eventual amputation.
CONCLUSION
DAIR's success rate for managing acute PJI in revision arthroplasty cases was 46% at 5 years. Of the 20 failed DAIR cases, 10 resulted in eventual amputation. DAIRs utility in managing these complicated PJI cases in the setting of revision arthroplasty is concerning with low success rates and high rates of amputation in failed cases. .
Topics: Humans; Prosthesis-Related Infections; Arthroplasty, Replacement, Knee; Retrospective Studies; Debridement; Male; Female; Reoperation; Anti-Bacterial Agents; Aged; Middle Aged; Aged, 80 and over; Knee Prosthesis; Treatment Outcome
PubMed: 38919369
DOI: No ID Found -
Annals of Vascular Diseases Jun 2024The most important vascular lesion associated with diabetes is arteriosclerosis obliterans (ASO). Differential diagnosis from diabetic foot lesions that produce... (Review)
Review
The most important vascular lesion associated with diabetes is arteriosclerosis obliterans (ASO). Differential diagnosis from diabetic foot lesions that produce neurogenic ulcers is important, and the presence of ischemia must be diagnosed as soon as possible. It has been reported that diabetes makes ASO more severe and often leads to lower extremity amputation. In addition to the need for appropriate early control of diabetes, vascular surgeons are required to perform immediate revascularization in cases of ulcer and necrosis, and to aggressively use surgical treatment with good long-term prognosis. (This is a translation of Jpn J Vasc Surg 2023; 32: 105-109.).
PubMed: 38919320
DOI: 10.3400/avd.ra.24-00010 -
PloS One 2024Factors associated with upper limb prosthesis adoption are not well understood. In this study, we explored how prosthesis usability experience relates to the extent of...
Factors associated with upper limb prosthesis adoption are not well understood. In this study, we explored how prosthesis usability experience relates to the extent of prosthesis adoption through the development of a structural equation model (SEM). First, items related to prosthesis usability were developed and refined using cognitive testing and pilot testing and employed in a survey of 402 prosthesis users (mean age 61.7 (sd 14.4), 77.1% Veterans). The SEM examined two unidimensional latent constructs: Prosthesis Usability Experience and Prosthesis Adoption-and each had multiple measured indicators. SEMs tested direct as well as moderating and mediating effects between the latent constructs and covariates related to demographics and prosthesis type. SEM found a significant positive association between Prosthesis Usability Experience and Extent of Prosthesis Adoption. Several covariates had direct effects on prosthesis adoption: 1) Extent of Prosthesis Adoption was lower for those with transhumeral and shoulder amputation, and higher for those with bilateral amputation, compared to the reference group with unilateral transradial amputation and 2) Myoelectric multiple degree of freedom (multi-DOF) prosthesis use was associated with lower Extent of Prosthesis Adoption, compared to body-powered prosthesis use. Myoelectric multi-DOF use also modified the effect of Prosthesis Usability Experience on Extent of Prosthesis Adoption. For those with bilateral ULA, the strength of the relationship between Prosthesis Usability Experience and Extent of Prosthesis Adoption was reduced. Findings suggest that in order to increase prosthesis adoption, prosthetics developers and rehabilitation providers should focus on implementing strategies to improve prosthesis usability experience. New Prosthesis Usability Experience measures could be used to identify persons at greater risk for poor prosthesis adoption and target interventions to increase prosthesis use.
Topics: Humans; Artificial Limbs; Male; Female; Middle Aged; Upper Extremity; Aged; Latent Class Analysis; Prosthesis Design; Amputation, Surgical; Amputees; Adult; Surveys and Questionnaires
PubMed: 38917074
DOI: 10.1371/journal.pone.0299155 -
BioRxiv : the Preprint Server For... Jun 2024Diabetic peripheral neuropathy (DPN) is a prevalent complication of diabetes mellitus that is caused by metabolic toxicity to peripheral axons. We aimed to gain deep...
Diabetic peripheral neuropathy (DPN) is a prevalent complication of diabetes mellitus that is caused by metabolic toxicity to peripheral axons. We aimed to gain deep mechanistic insight into the disease process using bulk and spatial RNA sequencing on tibial and sural nerves recovered from lower leg amputations in a mostly diabetic population. First, our approach comparing mixed sensory and motor tibial and purely sensory sural nerves shows key pathway differences in affected nerves, with distinct immunological features observed in sural nerves. Second, spatial transcriptomics analysis of sural nerves reveals substantial shifts in endothelial and immune cell types associated with severe axonal loss. We also find clear evidence of neuronal gene transcript changes, like in nerves with axonal loss suggesting perturbed RNA transport into distal sensory axons. This motivated further investigation into neuronal mRNA localization in peripheral nerve axons generating clear evidence of robust localization of mRNAs such as and in human sensory axons. Our work gives new insight into the altered cellular and transcriptomic profiles in human nerves in DPN and highlights the importance of sensory axon mRNA transport as an unappreciated potential contributor to peripheral nerve degeneration.
PubMed: 38915676
DOI: 10.1101/2024.06.15.599167 -
BioRxiv : the Preprint Server For... Jun 2024The mouse digit tip regenerates following amputation, a process mediated by a cellularly heterogeneous blastema. We previously found the gene Mest to be highly expressed...
The mouse digit tip regenerates following amputation, a process mediated by a cellularly heterogeneous blastema. We previously found the gene Mest to be highly expressed in mesenchymal cells of the blastema and a strong candidate pro-regenerative gene. We now show Mest digit expression is regeneration-specific and not upregulated in post-amputation fibrosing proximal digits. Mest homozygous knockout mice exhibit delayed bone regeneration though no phenotype is found in paternal knockout mice, inconsistent with the defined maternal genomic imprinting of Mest. We demonstrate that promoter switching, not loss of imprinting, regulates biallelic Mest expression in the blastema and does not occur during embryogenesis, indicating a regeneration-specific mechanism. Requirement for Mest expression is tied to modulating neutrophil response, as revealed by scRNAseq and FACS comparing wildtype and knockout blastemas. Collectively, the imprinted gene Mest is required for proper digit tip regeneration and its blastema expression is facilitated by promoter switching for biallelic expression.
PubMed: 38915675
DOI: 10.1101/2024.06.12.598713 -
Plastic and Reconstructive Surgery.... Jun 2024The aim of this study was to compare the use of pedicled local (PFs) versus random pattern flaps (RpFs) in foot and ankle reconstruction in patients with chronic,...
BACKGROUND
The aim of this study was to compare the use of pedicled local (PFs) versus random pattern flaps (RpFs) in foot and ankle reconstruction in patients with chronic, nonhealing wounds.
METHODS
A single-center, retrospective review of 204 patients with 118 PFs and 86 RpFs was performed. The primary outcome included rates of limb salvage.
RESULTS
PFs were used more often in the hindfoot (44.1% versus 30.2%, = 0.045), lateral and medial surface (39.8% versus 18.6%, = 0.001), and wounds containing exposed bone and hardware (78.8% versus 62.8%, = 0.018). RpFs were used more for forefoot (19.8% versus 10.2%, = 0.053) and plantar defects (58.1% versus 30.3%, = 0.000). RpFs had a higher rate of immediate success (100% versus 95.8%, = 0.053), with no significant differences in rate of long-term limb salvage (77.1% versus 69.8%, = 0.237). PFs had higher rates of ischemia requiring intervention (11.0% versus 3.5%, = 0.048). RpFs had a higher rate of minor amputations (15.12% versus 6.8%, = 0.053) but similar rates of major amputation (15.1% versus 16.1%, = 0.848). There were no significant differences in rates of mortality or ambulatory status.
CONCLUSIONS
Both RpFs and PFs remain reliable options to reconstruct defects of the foot and ankle. Optimizing the use of each flap type should consider wound characteristics. RpFs are preferred for dorsal and plantar defects, whereas PFs are protective for minor infections and preferred for deeper wounds despite a higher rate of partial necrosis.
PubMed: 38911575
DOI: 10.1097/GOX.0000000000005921 -
Journal of Orthopaedic Case Reports Jun 2024Cryptococccus neoformans is a fungus which typically presents in immunocompromised hosts, commonly presenting as meningoencephalitis. There have been very few documented...
INTRODUCTION
Cryptococccus neoformans is a fungus which typically presents in immunocompromised hosts, commonly presenting as meningoencephalitis. There have been very few documented incidents of intramuscular manifestations of this pathogen.
CASE REPORT
We report on a case of a 45-year-old caucasian male with disseminated Cryptococcus neoformans who developed cryptococcal intramuscular abscesses of all extremities and osteomyelitis of the left upper limb. Clinical treatment and surgical debridement of the forearm was performed. Persistent infection resulted in a left humeral amputation and ultimately the patient's death. This is one of the few documented intramuscular abscesses of Cryptococcus neoformans.
CONCLUSION
Orthopedic manifestations of cryptococcal infections are rare; however, awareness and prompt diagnosis may improve outcomes.
PubMed: 38910993
DOI: 10.13107/jocr.2024.v14.i06.4488 -
Journal of Orthopaedic Case Reports Jun 2024Charcot arthropathy consists of a rapid and destructive complication of the joints following the loss of innervation caused by many complicated etiologies. Diabetic...
INTRODUCTION
Charcot arthropathy consists of a rapid and destructive complication of the joints following the loss of innervation caused by many complicated etiologies. Diabetic neuropathy has become the most common etiological factor.
CASE REPORT
We present a case of a 64-year-old female patient with a history of chronic renal failure on hemodialysis, hypertension, hypothyroidism, and Type 2 diabetes, complicated with neuropathy and Charcot disease, who referred to our department. Initially, the patient was managed with a restraint orthotic device due to a bimalleolar ankle fracture. An unsuccessful treatment and the presence of a pressure ulcer with pus-like drainage on the lateral malleolus 2 months later led to the decision for a below-knee amputation.
CONCLUSION
High clinical suspicion by the attending physician may reduce the risk of complications and lead to proper treatment with better outcomes.
PubMed: 38910990
DOI: 10.13107/jocr.2024.v14.i06.4498