The treatment of periprosthetic infection remains one of the most difficult and challenging problems in orthopaedic surgery. Conventional approaches such as the use of tissue and/or fluid cultures to identify and treat organisms are not nearly as successful as they need to be in order to address these conditions. The limitations of treatment, including the inaccessibility of microorganisms at the time of irrigation and debridement, the development of resistant strains of microorganisms, and the elaboration by microorganisms of protective biofilms, have led to unsuccessful outcomes in a large number of cases.
In this issue of JBJS Reviews, Chen and Parvizi provide an update on some of the new methods that may possibly advance this field. Molecular methods such as polymerase chain reaction to amplify bacteria can improve the likelihood of identifying the pathogen in a patient with a periprosthetic joint infection. Synovial markers such as C-reactive protein, leukocyte esterase, α-defensin, human β-defensin-2 (HBD-2) and HBD-3, and cathelicidin LL-37 are known to be elevated in patients with periprosthetic joint infection and may be used as markers for diagnosing infection at the time of operative management. Serum markers such as interleukin-4 (IL-4) and IL-6, and others such as soluble intracellular adhesion molecule-1 (sICAM-1) and procalcitonin (PCT), have been shown to be elevated in patients with periprosthetic joint infection.
Molecular detection methods probably have received the most attention and interest as an advancement that may improve our ability to diagnose periprosthetic infections. The limitations of these methods, however, include their high sensitivity and an increased rate of false-positive results. Methods to reduce the number of false-positive results are currently in development and include, among other things, the measurement of 16S ribosomal RNA in the belief that targeting RNA will result in amplification of only the genetic material of live bacteria. In addition, use of the mecA gene for identifying methicillin-resistant Staphylococcus aureus (MRSA) can reduce this rate.
Although this article does not provide definitive new approaches to the problem, the review of recent advances with the development of promising biomarkers and molecular techniques provides optimism that this field is evolving in a positive way.
According to the orthopaedic surgeon edition of Kantar Media’s Website Usage & Qualitative Evaluation study, JBJS.org ranks hands down as the #1 orthopaedic site that surgeons visit most often and spend the most time on. The Kantar study evaluates the opinions of orthopaedic surgeons on 29 professional websites, including 8 orthopaedic sites. Not only does JBJS.org rank number 1 among the other 7 orthopaedic sites in frequency of visits (4.7 times/month), the website ranks first among all 28 sites evaluated in terms of time per session (20.31 minutes). Additionally, JBJS.org ranks #1 in delivering quality clinical content and keeping surgeons informed of the latest practices and procedures. JBJS ties for first place in the category of information on drugs, devices, or professional services. Also noteworthy is the fact that JBJS Reviews, a new online review journal from JBJS launched in November 2013, has already taken over third place in time spent and number of site visits.
JBJS Webinar Series
JBJS has held multiple live webinar events on a wide variety of topics, and we are pleased to announce the expansion of the JBJS Webinar Series in 2014. Each webinar has proven to be a successful tool in educating, informing and engaging orthopaedic surgeons around the world. In 2014, JBJS is continuing this educational program through a new series of interactive online events.
Our webinars bring together groups of authors to present recently published scientific research and data, and they include commentary from guest experts. Live Q&A sessions follow the author and commentator presentations to provide the audience with the opportunity to further explore the concepts and data presented. Webinars continue to be available on-demand for several months after the event.
AVAILABLE ON-DEMAND (Previously Recorded Events)
Total Knee Arthroplasty Critical Decision Making: Socioeconomic and Clinical Considerations (June 10, 2014) – Moderated by Charles R. Clark, MD
Panelists/Authors: Kevin J. Bozic, MD and Thomas S. Thornhill, MD
Commentators: Daniel J. Berry, MD and Kevin Garvey, MD
Preventing Arthroplasty-Associated Venous Thromboembolism (VTE) (May 12, 2014) – Moderated by Thomas A. Einhorn, MD
Panelists/Authors: Clifford W. Colwell Jr, MD and John T. Schousboe, MD
Commentators: Vincent Pellegrini Jr, MD and Jay Lieberman, MD
Anterior Cruciate Ligament (ACL) Reconstruction (March 5, 2014) – Moderated by Mark Miller, MD
Panelists/Authors: Freddie Fu, MD and Christopher Kaeding, MD
Commentators: Brett Owens, MD and Darren L. Johnson, MD
Adhesive Capsulitis/Frozen Shoulder (December 2013) – Moderated by Andrew Green, MD
Presented in conjunction with the Journal of Orthopaedic & Sports Physical Therapy.
Panelists/Authors: George Murrell, MD, Martin J. Kelley, DPT, Jo Hannafin, MD, PhD, and Philip W. McClure, PT, PhD
Periprosthetic Joint Infection (October 2013) – Moderated by Charles R. Clark, MD
Panelists/Authors: Kevin J. Bozic, MD and Craig J. Della Valle, MD
Commentators: Javad Parvizi, MD, FRCS, and Geoffrey Tsaras, MD, MPH
Measuring Value in Orthopaedic Surgery (September 2013) – Moderated by James Herndon, MD
Panelist/Author: Kevin J. Bozic, MD
Commentators: David Jevsevar, MD and Jon J.P. Warner, MD
Editor, JBJS Reviews: Thomas A. Einhorn, MD