Christina Pempe

Background: Periprosthetic joint infection (PJI) is a rare but serious complication after hip and knee arthroplasty. The diagnostic value of preoperative and early postoperative C-reactive protein (CRP) remains controversial. This study characterized perioperative CRP kinetics following primary arthroplasty, with particular emphasis on CRP dynamics in patients without early PJI and patient-related factors associated with marked postoperative CRP elevation. Methods: In this retrospective single-center study, 595 primary hip and knee arthroplasties performed in 546 patients with primary osteoarthritis were analyzed. Preoperative CRP and leukocyte counts were recorded. Postoperative CRP was assessed at days 1–3, 4–6, and 7–9. Early PJI (≤ 90 days) was defined according to the 2018 Musculoskeletal Infection Society (MSIS) criteria. CRP kinetics were primarily evaluated in infection-free patients, while CRP values in the small number of early PJI cases were reported descriptively. Subgroup analyses were performed based on data completeness and follow-up availability. Results: Among procedures with ≥ 90-day follow-up, seven early PJI cases were identified. In infection-free patients, CRP levels peaked during postoperative days 1–3, with 49.8% exhibiting CRP values > 100 mg/L and subsequently declined over time. After multivariable adjustment, pre-existing renal insufficiency (OR 2.49; 95% CI 1.16–5.34; p = 0.020) and male sex (OR 1.74; 95% CI 1.06–2.85; p = 0.029) were independently associated with postoperative CRP > 100 mg/L during days 1–3. Owing to the small number of early PJI cases, PJI-related CRP data were considered descriptive only. Conclusions: Marked early postoperative CRP elevations were common among patients without early PJI. Pre-existing renal insufficiency and male sex were independently associated with CRP values > 100 mg/L during postoperative days 1–3, highlighting substantial patient-related variability in the postoperative inflammatory response in patients without documented early PJI. These factors should be considered when interpreting early postoperative CRP values after primary arthroplasty. The small number of early PJI cases precluded assessment of the diagnostic performance of CRP for early PJI.

Purpose: Periprosthetic joint infection (PJI) is a serious complication after total joint arthroplasty, leading to repeated revisions, substantial costs, and increased morbidity. Oral pathologies have been suggested as possible sources of hematogenous infection, however their prevalence and impact on PJI outcomes remain unclear. This study aimed to determine the prevalence of dento-alveolar foci in hip or knee PJI patients and explore differences in outcomes. Methods: Patients with hip or knee periprosthetic joint infection (PJI) were retrospectively screened at a single center between 2020 and 2023. Inclusion required a confirmed diagnosis according to the 2018 International Consensus Meeting (ICM) criteria and a clinical and radiological dental assessment to identify dento-alveolar foci. Dento-alveolar foci were defined as pathological findings requiring therapeutic intervention. The primary outcome was the presence of a dental focus. Secondary outcomes included differences in outcomes, especially DAIR-failure and revision surgery rates between groups. Results: Among 213 PJI cases (mean 71.9 ± 10.4 years; 52% male), dento-alveolar foci were identified in 59/213 patients (27.7%). Prevalence was similar across infection type. DAIR failure occured in 6/22 patients (27.3%) vs. 26/61 patients (42.6%; p = 0.205) and revision surgery rates were 25/59 (42.4%) vs. 79/144 (54.9%; p = 0.106). No significant differences were observed between patients with and without dental foci. Baseline characteristics and infection patterns were comparable. Conclusion: Dento-alveolar foci were frequently detected in PJI patients but were not descriptively associated with differences in treatment outcomes. Immediate preemptive dental interventions may not be required during acute PJI management. Prospective studies are needed to clarify the clinical relevance of dental foci in PJI.

Background: Intravenous anti-infectives are an important part of postoperative care, but discrepancies between prescribed and documented administrations remain widespread and require systematic evaluation. Methods: In an exploratory study, prescribed and documented intravenous anti-infective administrations were retrospectively analyzed using patient charts, digital nursing reports and, in cases of deviations, consultations with the responsible staff. The discrepancies were classified into three categories: (I) documentation, (II) administration, and (III) a combination of both. The relationship between discrepancies and dosing interval, time of administration (weekday and shift assignment), and intravenous administration route was statistically analyzed (Χ² test, residual analysis). Results: Of 5016 anti-infective administrations in 219 patients, 1135 (22.6%) had at least one discrepancy, of which 68.2% (774 of 1135) belonged to category I. Significant differences in the frequency of discrepancies between surgical wards and the dosing intervals were observed. On weekdays, 23.6% of drug administrations (832 of 3519) showed discrepancies compared to 20.2% on weekends (303 of 1497, OR = 1.22, 95% CI 1.05–1.42, p = 0.008). Although the early shift had the lowest administration rate, it showed significantly more discrepancies than expected (313.6 expected vs. 553 observed; adjusted standardized residual +18.1; p < 0.001). Drug administration via the peripheral venous route was more susceptible to discrepancies than the central venous administration route (23.2% [963 of 4149] vs. 19.8% [172 of 867]), OR 1.18; 95% CI 1.01–1.38; p = 0.031). Conclusions: Approximately a quarter of anti-infective administrations were affected by discrepancies, predominantly in category I, with the highest incidences occurring during the early shift and on weekdays. This requires a multi-step improvement program.

Zusammenfassung: Hintergrund: Das Osteosyntheseversagen nach proximaler Femurfraktur stellt eine zunehmende Herausforderung in der Alterstraumatologie dar. In diesen Fällen ist häufig eine Konversions-Hüfttotalendoprothese (K-HTEP) erforderlich. Unklar ist, ob ein einzeitiges oder zweizeitiges Vorgehen hinsichtlich Infektionsrisiko und klinischem Outcome überlegen ist. Methodik: Es wurde eine Literaturrecherche in der Datenbank PubMed für den Zeitraum 1995–2025 durchgeführt. Eingeschlossen wurden Originalarbeiten, die das ein- oder zweizeitige Vorgehen nach Osteosyntheseversagen des proximalen Femurs untersuchten. Fallberichte, Editorials und Studien ohne Bezug zur Hüftendoprothetik wurden ausgeschlossen. Insgesamt wurden 17 Publikationen in die Analyse eingeschlossen. Auf Grundlage der Ergebnisse wurde ein klinischer Entscheidungsalgorithmus zur Therapieplanung in der eigenen Klinik entwickelt. Ergebnisse: Die verfügbare Evidenz basiert überwiegend auf retrospektiven Studien mit geringer Fallzahl. Infektionsraten nach K‑HTEP variieren erheblich zwischen den Studien (0–8,6 %). Einzelne Arbeiten zeigen Vorteile des zweizeitigen Vorgehens hinsichtlich Infektionskontrolle, während andere vergleichbare Ergebnisse für beide Strategien aufzeigen. Positive mikrobiologische Befunde trotz fehlender klinischer Infektzeichen sind häufig, ihre klinische Relevanz bleibt unklar. Schlussfolgerung: Die aktuelle Datenlage erlaubt keine eindeutige Empfehlung zugunsten eines ein- oder zweizeitigen Vorgehens. Entscheidend ist eine individuelle Risikostratifizierung unter Berücksichtigung klinischer, laborchemischer und radiologischer Parameter. Der vorgestellte klinische Algorithmus bietet einen praxisorientierten Ansatz zur Entscheidungsfindung. Prospektive, multizentrische Studien sind erforderlich, um belastbare Empfehlungen abzuleiten.

Background: The objective of this study was to compare infection rates, pathogen species detection and antimicrobial susceptibility testing in patients with total hip arthroplasty (THA) and total knee arthroplasty (TKA) following post-traumatic osteoarthritis (PTOA) and primary osteoarthritis (POA). Results: Patients undergoing both THA and TKA were significantly more likely to have a PJI after PTOA than after POA (THA: 2.5% vs. 10.2%, p = 0.003; TKA: 3.2% vs. 10.3%, p = 0.028). The most frequently detected pathogen in both THA and TKA was Staphylococcus spp. Among patients with a PJI in THA, Staphylococcus spp. was detected in 47% after POA and 60% after PTOA. Among patients with a PJI in TKA, Staphylococcus spp. was isolated in 59% after POA and 80% after PTOA. The remaining pathogens were mainly Enterococcus spp., Enterobacterales and anaerobic bacteria. After THA, beta-lactam-resistant staphylococcal isolates were detected more frequently in PTOA patients than in POA patients (13% vs. 100%, p = 0.024). There was no difference in the beta-lactam staphylococcal resistance rate in patients after TKA (20% vs. 25%, p = 0.945). Furthermore, an analysis of susceptibility testing from all groups showed that significantly more pathogens were susceptible to vancomycin than to cefuroxime (76% vs. 45%, p < 0.001) or clindamycin (76% vs. 52%, p = 0.007). Methods: A retrospective analysis was performed using clinic-owned data during the period January 2016–December 2020. A total of 1485 patients following primary implantation of THA or TKA due to PTOA or POA were included. Early-onset periprosthetic joint infection (PJI), defined according to the 2018 Definition of Periprosthetic Hip and Knee Infection Criteria, was evaluated. Conclusions: Therefore, the use of vancomycin as a perioperative prophylaxis should be discussed under benefit/risk consideration in further studies.

Zusammenfassung Trotz limitierter Evidenz für eine präoperative zahnärztliche Screeninguntersuchung und bedarfsgerechter Fokussanierung, sowie der Notwendigkeit einer Antibiotikaprophylaxe vor invasiven zahnärztlichen Eingriffen, ist und bleibt Mundgesundheit ein relevantes Thema in der Endoprothetik. Der Aspekt der Mundgesundheit sollte auch zukünftig im Zusammenhang mit periprothetischen Infektionen nicht vernachlässigt werden und weiter Gegenstand intensiver Forschung sein. Die Häufigkeit auffälliger Zahnbefunde im mittleren und hohen Lebensalter unterstreicht die Wichtigkeit dieser Problematik. Eine zahnärztliche Untersuchung vor Endoprothesenimplantation kann dabei grundsätzlich zur Minimierung des Endoprotheseninfektionsrisikos beitragen. Wünschenswert ist, dass mittels weiterer Studien Evidenz zu dieser Thematik geschaffen wird, um Handlungsempfehlungen auszusprechen. Unabhängig davon wäre die Erarbeitung einer interdisziplinären Leitlinie (Endoprothetik und Zahnmedizin) zu diesem Thema anzuregen. Diese könnte dazu beitragen, dass standardisierte Behandlungsabläufe flächendeckend in den klinischen Alltag integriert werden.

Periprosthetic joint infections (PJI) are serious complications after arthroplasty, associated with high morbidity, mortality, and complex treatment processes. The outcomes of different PJI entities are largely unknown. The aim of this study was to access the early outcomes of different PJI entities. A retrospective, single-center study was conducted. The characteristics and outcomes of patients with PJI treated between 2018 and 2019 were evaluated 12 months after the completion of treatment. Primary endpoints were mortality, relapse free survival (RFS) and postoperative complications (kidney failure, sepsis, admission to ICU). A total of 115 cases were included [19.1% early (EI), 33.0% acute late (ALI), and 47.8% chronic infections (CI)]. Patients with ALI were older (p = 0.023), had higher ASA scores (p = 0.031), preoperative CRP concentrations (p = 0.011), incidence of kidney failure (p = 0.002) and sepsis (p = 0.026). They also tended towards higher in-house mortality (ALI 21.1%, 13.6% EI, 5.5% CI) and admission to ICU (ALI 50.0%, 22.7% EI, 30.9% CI). At 12 months, 15.4% of patients with EI had a relapse, compared to 38.1% in ALI and 36.4% in CI. There are differences in patient characteristics and early outcomes between PJI entities. Patients with EI have better early clinical outcomes. Patients with ALI require special attention during follow-up because they have higher occurrences of relapses and postoperative complications than patients with EI and CI.