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GGC Medicines has been designed as a tool to assist in promoting high quality, safe and cost-effective prescribing within the Greater Glasgow and Clyde Health Board. The GGC Medicines app is password protected to ensure that it is only used by clinical staff within NHSGGC. The contents and guidelines from the Adult Therapeutics Handbook can also be accessed by a new desktop site to ensure that users of PCs and smartphones other than those the app is available for can access this invaluable clinical resource. GGC Medicines App Update: The app has had a routine update to ensure it works optimally on the latest mobile device operating systems. In the near future your device will prompt you to update the app. CHANGE OF PHONE NUMBER: Please note that should this service be required to be contacted, the phone number has recently changed. For citation purposes: Clement ND, Burnett R, Breusch SJ.
Should single- or two-stage revision surgery be used for the management of an infected total knee replacement? A critical review of the literature. Treatment Should single- or two-stage revision surgery be used for the management of an infected total knee replacement? In this paper, we present the current evidence to support a single-stage revision of a TKR for periprosthetic infection and compare the outcome with that of a two-stage revision procedure. As to whether a single- or a two-stage procedure should be undertaken needs to be personalized to each patient and their circumstances. The rate of periprosthetic infection of TKR varies and is dependent upon the length of follow-up, but it is generally accepted that the rate is between 0.
The microorganism attaches itself to the surface of the prosthesis and produces a biofilm, which forms between 36 h and 3 weeks. The key to effectively managing patients with a prosthetic infection of a TKR is early and accurate diagnosis. The presentation can, however, be varied and a definitive diagnosis may be challenging. There is no definitive single test to establish a diagnosis, and relies on a combination of clinical signs and symptoms, laboratory investigations and radiographic studies. There is a vast spectrum of clinical presentations of patients suffering with a prosthetic joint infection, which can vary from systemic sepsis to chronic indolent low-grade infection. Figure 1: Multiple discharging sinuses from a chronically infected TKR. 91, and a specificity of 0.
In a patient with TKR who is suspected to have a prosthetic joint infection, an aspiration of the joint should be obtained. This does carry a risk of potentially infecting the TKR, if it is not already, and with such a risk this should be carried out under a strict aseptic technique in an operating theatre. Synovial fluid cell count and differential is a very useful diagnostic test. Molecular diagnosis using PCR to amplify strains of bacterial DNA enables identification of the potential pathogen. It can be used to identify non-viable bacteria and is thought to be a quick method, and whether a patient has received antibiotics does not affect this method. However, a high percentage of false-negative test results have been reported using such methodology. The biofilm formed over the surface of the implant by the microorganism can prevent growth and identification of the pathogen.
Ultrasonication lyses the bacteria, making them void to culture, and then PCR can be used to identify the pathogen. Frozen histological sections are used to assist decision-making in cases with equivocal serum inflammatory makers and aspirate cytology. Figure 2: Lateral radiograph of an infected TKR demonstrating a loose femoral component. A technetium bone scan remains positive more than 1 year after implantation because of increased periprosthetic bone remodelling. Overall, the potential value of bone scanning for the diagnosis of PPJI remains controversial. They defined four groups based upon the clinical presentation of the patient that also aids management decisions. The management of the infected TKR is complex and expensive, with an ultimate goal of eradicating the infection and leaving the patient with a pain-free and functioning TKR.
Figure 4: A lateral radiograph of the knee demonstrating a static cement spacer that was inserted during the first part of the two-stage revision procedure. TKR implanted as part of a second-stage procedure for infection of a primary TKR. Discussion The authors have referenced some of their own studies in this review. All human subjects, in these referenced studies, gave informed consent to participate in these studies. A single-stage revision is advocated by some orthopaedic surgeons in specific case scenarios.
Table 1 Relative contraindications to attempt single-stage revision surgery for a periprosthetic infection suggested by Oussedik et al. TKR, there will be more and more patients presenting to orthopaedic services with an infected TKR. Authors contribution All authors contributed to the conception, design, and preparation of the manuscript, as well as read and approved the final manuscript. Infection following total knee arthroplasty: prevention and management.
Review article: risk factors of infection following total knee arthroplasty. Vanhegan IS, Morgan-Jones R, Barrett DS, Haddad FS. Data is only gathered for undergraduate full-time courses. There are a number of reasons why this course does not have KIS data associated with it. For example, it may be a franchise course run at a partner college or a course designed for continuing professional development. Our state of the art laboratories, set up to simulate hospital ward and critical care environments, are the perfect place to learn, develop and practice your skills.
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