We studied the prevention and treatment of prosthetic joint infections. This topic is of interest because the number of annually performed arthroplasty procedures is rising worldwide.Antibiotics... Show moreWe studied the prevention and treatment of prosthetic joint infections. This topic is of interest because the number of annually performed arthroplasty procedures is rising worldwide.Antibiotics are prophylactically administered to arthroplasty patients, but to date it remained unclear how many doses of prophylaxis provided the best protection. 90% of hospitals provide multiple doses, while 10% of hospitals administer a single dose prophylaxis.Our study shows that, with 242.179 included patients from the LROI database, there seems to be no difference in the risk of complete revision for infection between single dose and multiple dose prophylaxis.We have also evaluated several treatment options for two-stage revision of infected hip and knee prostheses.The use of a functional articulating antibiotic loaded spacer leads to a comparable infection eradication rate, improved patient reported outcome and less complications compared to a prefabricated standard spacer Show less
BACKGROUND Periprosthetic joint infections (PJIs) are frequently caused by coagulase-negative Staphylococci (CoNS), which is known to be a hard-to-treat microorganism. Antibiotic resistance among... Show moreBACKGROUND Periprosthetic joint infections (PJIs) are frequently caused by coagulase-negative Staphylococci (CoNS), which is known to be a hard-to-treat microorganism. Antibiotic resistance among causative pathogens of PJI is increasing. Two-stage revision is the favoured treatment for chronic CoNS infection of a hip or knee prosthesis. We hypothesised that the infection eradication rate of our treatment protocol for two-stage revision surgery for CoNS PJI of the hip and knee would be comparable to eradication rates described in the literature. AIM To evaluate the infection eradication rate of two-stage revision arthroplasty for PJI caused by CoNS. METHODS All patients treated with two-stage revision of a hip or knee prosthesis were retrospectively included. Patients with CoNS infection were included in the study, including polymicrobial cases. Primary outcome was infection eradication at final follow-up. RESULTS Forty-four patients were included in the study. Twenty-nine patients were treated for PJI of the hip and fifteen for PJI of the knee. At final follow-up after a mean of 37 mo, recurrent or persistent infection was present in eleven patients. CONCLUSION PJI with CoNS can be a difficult to treat infection due to increasing antibiotic resistance. Infection eradication rate of 70%-80% may be achieved. Show less
This thesis described the stepwise development and execution of a de-implementation strategy to reduce the use of the low-value blood salvage techniques and preoperative treatment with... Show moreThis thesis described the stepwise development and execution of a de-implementation strategy to reduce the use of the low-value blood salvage techniques and preoperative treatment with erythropoietin in primary elective hip and knee arthroplasty. The implementation model of Grol was used to develop de-implementation goals, to identify barriers that hinder de-implementation, to develop a de-implementation strategy and to execute and evaluate the developed de-implementation strategy. The intention of de-implementing low-value patient blood-management techniques was to reduce costs and improve the quality of healthcare. However, this thesis showed that a tailored de-implementation strategy is not necessarily successful. When evaluating the effects we found that in the group of hospitals that were exposed to the de-implementation strategy the reduction in blood salvage techniques and erythropoietin was comparable to the control group hospitals. We did found that the reduction in blood salvage techniques was associated with the increased use of local analgesic infiltration and the use of tranexamic acid, an antifibrinolytic drug to prevent excessive blood loss. We found that the substitution of low-value care might contribute to de-implementation of this low-value care. In future de-implementation efforts this can be used to improve the results. Show less
Keijsers, R.; Delft, R. van; Bekerom, M.P.J. van den; Vries, D.C.A.A. de; Brohet, R.M.; Nolte, P.A. 2015
