Musculoskeletal Infection

Contents
About the Editor
Chapter 1: The Musculoskeletal Burden: Where Are We Now?
1.1 The Global Rise in Our Aging Population
1.2 The Global Burden of Musculoskeletal Disorders
1.3 Current Societal Challenges
1.3.1 Physical Inactivity
1.3.2 Obesity
1.3.3 Age and Gender
1.3.4 Diet and Nutrition
1.3.5 Smoking
1.4 Growth of the Orthopaedic Device Market
1.5 Musculoskeletal Infection
1.6 Aim
References
Chapter 2: Bacterial Adhesion, Virulence, and Biofilm Formation
2.1 Overview
2.2 Host Response to the Insertion of a Non-phagocytosable Implant
2.3 Bacteria Associated with Implant and Tissue Infection
2.3.1 Staphylococcus aureus
2.3.2 Pseudomonas aeruginosa
2.4 Immune and Cell Response to Bacteria
2.4.1 Immune and Bacterial Cell Response During Invasion
2.4.2 Bacterial Virulence Factors
2.4.2.1 Staphylococcus aureus Virulence Factors
2.4.2.2 Pseudomonas aeruginosa Virulence Factors
2.4.3 Bacterial Invasion of Host Cells
2.5 Bacterial Adhesion to Surfaces
2.5.1 Environmental Factors
2.5.2 Biomaterial Surface Properties and Surface Modification
2.6 Biofilm Formation
2.6.1 Staphylococcus aureus Biofilm Formation
2.6.1.1 Capsular Polysaccharides
2.6.1.2 Polysaccharide Intercellular Adhesin/Poly-N-Acetylglucosamine
2.6.1.3 Wall Teichoic Acid
2.6.1.4 Quorum Sensing
2.6.2 Pseudomonas aeruginosa Biofilm Formation
2.6.2.1 Bacterial Detachment and Dispersion
2.6.2.2 Quorum Sensing
References
Chapter 3: Prevention of Infection: Best Practice and Novel Strategies
3.1 Introduction
3.2 Host Factors/Risk Mitigation
3.3 Surgical Technique and Surgical Site Preparation
3.3.1 Skin Cleansing
3.3.2 Hair Removal
3.4 Operating Room Environment (Laminar Flow)/Personnel
3.4.1 Laminar Flow
3.4.2 Operating Room Traffic
3.4.3 Gowns
3.5 Anesthesia and Blood Conservation/Tranexamic Acid
3.6 Intraoperative Measures (Irrigation Solutions, Antimicrobial Powder, Operative Time)
3.6.1 Irrigation Solutions
3.6.2 Antimicrobial Powder
3.6.3 Operative Time
3.7 Antibiotic Prophylaxis
3.7.1 Current Recommendation
3.7.2 Routes of Administration
3.8 Antimicrobial Resistance
3.9 Wound Dressings and Topical Antimicrobial Products
3.9.1 Occlusive vs. Silver Impregnated vs. Dry Gauze
3.9.2 Antimicrobial-Coated Sutures
3.9.3 Vacuum-Assisted Dressings
3.9.4 Topical Incisional Sealants
3.9.5 Biofilm Mapping: Detection and Localization
3.10 Biomaterials, Carriers, Coatings, and Novel Technologies
3.10.1 Material Composition of Orthopedic Components
3.10.2 Intrinsically Bioactive Materials
3.10.3 Bioactive Antibacterial Coatings and Surface Modification
3.10.4 Antibiotic Carriers
3.11 Novel Technologies
3.11.1 Nanotubes
3.11.2 Bacteriophages
3.11.3 Vaccines
3.11.4 Bioactive Enzymes
3.11.5 Shockwave Treatment, Electromagnetic Fields, and Electrical Stimulation
3.12 Conclusion
References
Chapter 4: Prosthetic Infection: Colonization and Diagnosis
4.1 What Is a Prosthetic Joint Infection (PJI) and How Is It Classified?
4.1.1 Implant Use in the USA
4.1.2 Morbidity and Mortality of Prosthetic Joint Infection (PJI)
4.1.3 Classification of PJI
4.2 PJI Pathogenesis, the “Golden Period,” and the Role of Biofilm
4.2.1 Pathogenesis of Infection
4.2.2 The “Golden Period”
4.2.3 Role of Biofilm and Mechanisms of Resistance
4.3 How to Diagnose PJI
4.3.1 Definition Criteria in Diagnosing PJI
4.4 Tests and Tools for Diagnosing PJI
4.4.1 Serum-Based Markers
4.4.1.1 ESR and CRP
4.4.1.2 D-dimer and Fibrinogen
4.4.1.3 Procalcitonin
4.4.1.4 Interleukin-6 (Serum and Synovial)
4.4.2 Synovial Fluid-Based Markers
4.4.2.1 White Blood Cell Count and Neutrophil Differential
4.4.2.2 Synovial CRP
4.4.2.3 Alpha-Defensin
4.4.2.4 Leukocyte Esterase
4.4.3 Culture Diagnosis
4.4.4 Molecular Diagnosis Techniques: PCR and Gene Sequencing
4.5 Conclusions
Appendix 1: AAOS Clinical Practice Guidelines for Diagnosing Prosthetic Joint Infection (Adapted from AAOS Clinical Practice Guidelines)
References
Chapter 5: Soft Tissue Infections
5.1 Overview
5.2 Cellulitis
5.2.1 A Diagnostic Challenge?
5.2.2 Risk Factors
5.2.3 Etiology
5.2.4 Treatment
5.3 Soft Tissue Abscess
5.4 Tenosynovitis and Myositis
5.4.1 Tenosynovitis
5.4.2 Myositis
5.5 Necrotizing Fasciitis (RSM)
5.6 Wound Management and Reconstruction
5.7 Novel Therapies for Wound Care
5.7.1 Dressings
5.7.2 Placental-Derived Membranes
References
Chapter 6: Incidence, Complications, and Novel Treatment Strategies: Diabetic Ulcer of the Limb
6.1 At-Risk Patients
6.2 Diabetic Neuropathy
6.3 Diabetic Foot Infection
6.3.1 Identification of a DFI
6.3.2 Osteomyelitis
6.3.3 Serum Inflammatory Indicators
6.3.4 Imaging in the Diagnosis of DFI and Osteomyelitis
6.3.5 Microbiology in DFIs
6.3.6 Antibiotic Therapy and Treatment in DFIs
6.4 Diabetic Foot Deformity
6.4.1 Charcot Foot
6.5 Diabetic Foot Ischemia
6.6 Basic Treatment
6.6.1 Debridement
6.6.2 Offloading
6.6.3 Advanced Dressings
6.7 Novel Treatment Strategies
6.7.1 Hyperbaric Oxygen Therapy (HBOT)
6.7.2 Negative Pressure Wound Therapy
6.7.3 Bioengineered Skin
6.7.4 Platelet-Rich Plasma
6.7.5 Physical Therapy
6.7.6 Ozone Therapy
6.7.7 Cold Atmospheric Plasma Therapy
6.7.8 Stem Cells
6.8 Other Lower Limb Infections in Diabetes
6.9 COVID-19 Pandemic and Diabetic Limb
6.10 Conclusions
References
Chapter 7: Incidence, Complications, and Novel Treatment Strategies: Osteomyelitis
7.1 Introduction
7.2 Incidence
7.3 General Complications
7.3.1 Systemic Sepsis
7.3.2 Chronic Disease Manifestations
7.4 Specific Complications
7.4.1 Osteonecrosis
7.4.2 Chronic Osteomyelitis
7.4.3 Subacute Osteomyelitis
7.4.4 Chronic Recurrent Multifocal Osteomyelitis
7.4.5 Sclerosing Osteomyelitis of Garré
7.4.6 Malignant Transformation in Chronic Osteomyelitis (Marjolin’s Ulcer)
7.4.7 Amputation
7.4.8 Deformity
7.4.9 Fracture
7.5 Innovation in Osteomyelitis Treatments: Pediatric
7.6 Innovations in Osteomyelitis Treatments: Adults
7.6.1 Innovations in Diagnosis
7.6.2 Cultures and Culture-Independent Methods
7.6.3 Imaging
7.6.4 Treatment
7.6.5 Antibiotics
References
Chapter 8: Incidence, Complications and Novel Treatment Strategies: Joint Arthroplasty
8.1 Introduction
8.2 Treatment
8.2.1 General Considerations
8.3 Current Surgical Strategies
8.3.1 Antibiotic Suppression
8.3.2 Debridement, Antibiotics and Implant Retention (DAIR)
8.3.3 One- or Two-Stage Exchange
8.3.4 Salvage
8.4 Knee Arthroplasty
8.5 Hip Arthroplasty
8.6 Ankle Arthroplasty
8.7 Shoulder Arthroplasty
8.8 Elbow Arthroplasty
8.9 Novel Treatment Strategies
8.9.1 Organisational Innovations
8.9.2 Novel Treatment Modalities
8.9.2.1 Inhibition of Transmission
8.9.2.2 Anti-adhesion
8.9.2.3 Metabolic Modulation
8.9.2.4 Biofilm Dispersion
8.9.2.5 Novel Antimicrobial Agents
8.9.2.6 Immunotherapy
8.9.2.7 Cellular Internalisation
8.10 Conclusion
References
Chapter 9: Incidence, Complications and Novel Treatment Strategies: Massive Bone Tumour Surgery
9.1 Overview
9.2 Epidemiology
9.3 Surgical Treatment Strategies
9.3.1 Allograft Reconstruction
9.3.2 Rotationplasty
9.3.3 Endoprosthesis
9.4 Endoprosthetic Periprosthetic Infection
9.5 Novel Strategies
9.5.1 A Silver Coating to Combat Infection
9.5.2 Additive Manufacturing
9.6 Conclusion
References
Chapter 10: Incidence, Complications, and Novel Treatment Strategies: Pediatric Spinal Surgery and Management
10.1 Introduction
10.2 Incidence and Epidemiology
10.3 Common Surgeries and Approaches
10.3.1 Scoliosis
10.3.2 Spondylolysis and Spondylolisthesis
10.3.3 Cervical Spine Instability
10.3.4 Disc Herniations
10.4 Complications
10.5 Microbiology
10.6 Minimizing Wound Contamination Preoperatively
10.7 Minimizing Wound Contamination Intraoperatively and Postoperatively
10.8 Wound Drains
10.9 Wound Vacuum-Assisted Closure (VAC)
10.10 Clinical Presentation and Diagnosis
10.11 Management of Surgical Site Infections
10.11.1 Medical Management
10.11.2 Surgical Management
10.11.3 Prognosis
10.12 Novel Treatments in Minimizing Surgical Spine Infections
References
Chapter 11: War Wounds and Orthopedic Trauma Devices
11.1 Introduction
11.2 Initial Management of War Wounds
11.2.1 Prehospital Management and Point-of-Injury Antibiotics
11.2.2 Initial Surgical Management
11.2.3 Unique Injury Patterns to OIF/OEF: The Dismounted Complex Blast Injury Pattern
11.2.4 Perioperative Antimicrobials
11.2.5 Local Wound Care and Antibiotic Delivery
11.2.6 Infection Control and Prevention
11.3 War Wound Infections
11.3.1 Introduction
11.3.2 Epidemiology
11.3.3 Microbiology
11.3.4 Diagnosis
11.3.5 Complications
11.3.6 Therapy
11.4 Combat-Related Osteomyelitis and Orthopedic Device-Related Infections
11.4.1 Introduction
11.4.2 Epidemiology
11.4.3 Microbiology
11.4.4 Diagnosis
11.4.5 Complications
11.4.6 Therapy
11.5 Combat-Related Invasive Fungal Wound Infections
11.5.1 Introduction
11.5.2 Epidemiology
11.5.3 Microbiology
11.5.4 Diagnosis
11.5.5 Complications
11.5.6 Therapy
11.5.7 Prevention
11.6 Research and Ways Forward
11.7 Conclusion
References
Index