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Department of Orthopaedic Surgery, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
Queensland University of Technology (QUT), Brisbane, Queensland, Australia
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Department of Orthopaedics, St. Vincent’s Hospital, Fitzroy, Victoria, Australia
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Prosthetic joint infection (PJI) is one of the most devastating complications for a patient following arthroplasty.
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This scoping review aims to evaluate the burden of PJI on individual patients and the healthcare system regarding the mortality rate, patient-reported quality of life, and healthcare resource utilisation.
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Patients with PJI have up to a five-fold higher mortality rate than those who have undergone an uninfected primary arthroplasty. There is an increased use of ambulatory aids and reduced joint function scores in patients with PJI. Global quality of life is poorer, specifically measured by the EQ-5D. Direct hospitalisation costs are two- to five-fold higher, attributed to surgery and prostheses, antibiotics, and a prolonged inpatient stay.
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There is an immense clinical and health economic burden secondary to PJI worldwide. This is expected to rise exponentially due to the increasing number of primary procedures and an ageing population with comorbidities
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Improving preventative and treatment strategies is imperative for patients and the healthcare system.
School of Health Sciences and Physiotherapy, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
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Neurophysiology Research Laboratory, School of Medical and Health Sciences, Centre for Human Performance, Edith Cowan University, Joondalup, Western Australia, Australia
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Australian Ballet, Southbank, Victoria, Australia
Victorian Institute of Sport, Albert Park Victoria, Australia
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Neurophysiology Research Laboratory, School of Medical and Health Sciences, Centre for Human Performance, Edith Cowan University, Joondalup, Western Australia, Australia
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La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Bundoora, Victoria, Australia
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Purpose
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The aim of the study was to quantify motor cortex descending drive and voluntary activation (VA) in people with lower-limb OA compared to controls.
Methods
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A systematic review and meta-analysis according to the PRISMA guidelines was carried out. Seven databases were searched until 30 December 2022. Studies assessing VA or responses to transcranial magnetic stimulation (TMS; i.e. motor evoked potential, intracortical facilitation, motor threshold, short-interval intracortical inhibition, and silent period) were included. Study quality was assessed using Joanna Briggs Institute criteria and evidence certainty using GRADE. The meta-analysis was performed using RevMan inverse variance, mixed-effect models.
Results
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Eighteen studies were included, all deemed low-quality. Quadriceps VA was impaired with knee OA compared to healthy controls (standardised mean difference (SMD) = 0.84, 95% CI = −1.12–0.56, low certainty). VA of the more symptomatic limb was impaired (SMD = 0.42, 95% CI = −0.75–0.09, moderate certainty) compared to the other limb in people with hip/knee OA. As only two studies assessed responses to TMS, very low-certainty evidence demonstrated no significant difference between knee OA and healthy controls for motor evoked potential, intracortical facilitation, resting motor threshold or short-interval intracortical inhibition.
Conclusions
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Low-certainty evidence suggests people with knee OA have substantial impairments in VA of their quadriceps muscle when compared to healthy controls. With moderate certainty we conclude that people with hip and knee OA had larger impairments in VA of the quadriceps in their more painful limb compared to their non-affected/other limb.
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Study Guidelines Clinical evidence (grade) Duration of prophylaxis ACCP (2008 19 , 2012 31 ) LMWH Low dose UFH VKA Fondaparinux Apixaban Dabigatran Rivaroxaban Aspirin IPCD 1B 1B 1B 1B 1B 1B 1B 1B 1C At least 10 to 14 days
Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Centre, Leiden, The Netherlands
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-hospital variation for revision. Revision Studies ( n = 6) Registry reports ( n = 8) THA ( n = 5) (4,15,20,25,31) TKA ( n = 4) (4,8,25,31) THA ( n = 13) (A 1 ,A 2 ,B 1 ,B 2 ,D 1 ,D 2 ,D 3 ,E 1 ,E 2 ,G 1 ,G 2 ,G 3 ,H) TKA ( n = 13
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103–B 18 – 25 ( https://doi.org/10.1302/0301-620X.103B1.BJJ-2020-1381.R1 ). 33380199 2. Mirza SZ Richardson SS Kahlenberg CA Blevins JL Lautenbach C Demetres M Martin L Szymonifka J Sculco PK Figgie MP , Diagnosing prosthetic
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OA osteoblasts also express high levels of inflammatory cytokines such as transforming growth factor b1 (TGFb1) and prostaglandin E2 (PGE2). Overexpression of inflammatory cytokines is thought to contribute to subchondral bone disturbance. Figure 6
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Department of Orthopaedics and Trauma Surgery, Medical University of Vienna, Austria
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of Prosthetic Joint Infection: a practical guide for clinicians . Bone and Joint Journal 2021 103-B 18 – 25 . ( https://doi.org/10.1302/0301-620X.103B1.BJJ-2020-1381.R1 ) 6. Sigmund IK Holinka J Staats K Sevelda F Lass R Kubista B
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E2 and interleukin-1, an enhanced expression of cyclo-oxygenase-2, growth factors including TGF-β and platelet-derived growth factor (PDGF), insulin-like growth factor-1 (IGF-1) and neurotransmitters such as glutamate and substance B. 1 , 58
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Wouthuyzen-Bakker M Chen AF Soriano A Vogely HC Clauss M Higuera CA & Trebse R . The EBJIS definition of periprosthetic joint infection . Bone and Joint Journal 2021 103–B 18 – 25 . ( https://doi.org/10.1302/0301-620X.103B1.BJJ-2020-1381.R1
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://doi.org/10.1302/0301-620X.101B1.BJJ-2018-0233.R1 ) 8 Pes M Pulino A Pisanu F & Manunta AF . Why malnutrition in orthopaedic elective patient is still an issue? A recent review of the literature . European Journal of Orthopaedic Surgery
