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Kuiper J.W.P.,Center for Orthopaedic Research Alkmaar | Van Den Bekerom M.P.J.,Onze Lieve Vrouwe Gasthuis | Van Der Stappen J.,University Hospitals Leuven | Nolte P.A.,Spaarne Hospital | Colen S.,University Hospitals Leuven
Acta Orthopaedica | Year: 2013

Background and purpose Fungal prosthetic joint infections are rare and difficult to treat. This systematic review was conducted to determine outcome and to give treatment recommendations. Patients and methods After an extensive search of the literature, 164 patients treated for fungal hip or knee prosthetic joint infection (PJI) were reviewed. This included 8 patients from our own institutions. Results Most patients presented with pain (78%) and swelling (65%). In 68% of the patients, 1 or more risk factors for fungal PJI were found. In 51% of the patients, radiographs showed signs of loosening of the arthroplasty. Candida species were cultured from most patients (88%). In 21% of all patients, fungal culture results were first considered to be contamination. There was co-infection with bacteria in 33% of the patients. For outcome analysis, 119 patients had an adequate follow-up of at least 2 years. Staged revision was the treatment performed most often, with the highest success rate (85%). Interpretation Fungal PJI resembles chronic bacterial PJI. For diagnosis, multiple samples and prolonged culturing are essential. Fungal species should be considered to be pathogens. Co-infection with bacteria should be treated with additional antibacterial agents. We found no evidence that 1-stage revision, debridement, antibiotics, irrigation, and retention (DAIR) or antifungal therapy without surgical treatment adequately controls fungal PJI. Thus, staged revision should be the standard treatment for fungal PJI. After resection of the prosthesis, we recommend systemic antifungal treatment for at least 6 weeks-and until there are no clinical signs of infection and blood infection markers have normalized. Then reimplantation can be performed. © Nordic Orthopaedic Federation.


Hoozemans M.J.M.,VU University Amsterdam | Hoozemans M.J.M.,Center for Orthopaedic Research Alkmaar | Koppes L.L.J.,TNO | Twisk J.W.R.,VU University Amsterdam | Van Dieen J.H.,VU University Amsterdam
Spine | Year: 2012

STUDY DESIGN.: Longitudinal study of lumbar bone mass as predictor of low back pain (LBP). OBJECTIVE.: To investigate whether low bone mineral content (BMC) and bone mineral density (BMD) values at the age of 36 years are associated with the prevalence of LBP at the age of 42 years among the study population of the Amsterdam Growth and Health Longitudinal Study. SUMMARY OF BACKGROUND DATA.: Results of epidemiological, clinical, and in vitro studies indicate that spinal injuries, caused by mechanical loading, might be a cause of LBP. BMC and BMD are determinants of spinal strength. We therefore hypothesized that BMC and BMD are associated with LBP. METHODS.: At the age of 36 years, the lumbar BMC and BMD were determined by dual-energy x-ray absorptiometry in 140 men and 152 women. At the age of 42 years, the participants were asked whether they had experienced LBP in the previous 12 months. Logistic regression analyses were performed to determine odds ratios (ORs)-adjusted for stature, body weight, physical activity, and smoking-for the relationship of BMC and BMD with LBP. RESULTS.: BMC and BMD at the age of 36 years were significantly associated with the reported 12-month prevalence of LBP at the age of 42 years. This association, however, was observed only for men and not for women. Men within the quartile with the lowest BMC or BMD values had higher odds for LBP with ORs of 4.78 (95% confidence interval, 1.52-15.00) and 3.48 (95% confidence interval, 1.23-9.85), respectively. CONCLUSION.: For a male population that is not characterized by osteoporosis or old age, lower lumbar BMC and BMD values at the age of 36 years are associated with an increased risk of reporting to have had LBP in the previous 12 months at the age of 42 years. Copyright © 2012 Lippincott Williams & Wilkins.


Willigenburg N.W.,VU University Amsterdam | Kingma I.,VU University Amsterdam | Hoozemans M.J.M.,VU University Amsterdam | Hoozemans M.J.M.,Center for Orthopaedic Research Alkmaar | van Dieen J.H.,VU University Amsterdam
Human Movement Science | Year: 2013

Motor control is challenged in tasks with high precision demands. In such tasks, signal-dependent neuromuscular noise causes errors and proprioceptive feedback is required for optimal performance. Pain may affect proprioception, muscle activation patterns and resulting kinematics. Therefore, we investigated precision control of trunk movement in 18 low back pain (LBP) patients and 13 healthy control subjects. The subjects performed a spiral-tracking task requiring precise trunk movements, in conditions with and without disturbance of proprioception by lumbar muscle vibration. Tracking task performance and trunk muscle electromyography were recorded. In conditions without lumbar muscle vibration, tracking errors were 27.1% larger in LBP patients compared to healthy controls. Vibration caused tracking errors to increase by 10.5% in healthy controls, but not in LBP patients. These results suggest that reduced precision in LBP patients might be explained by proprioceptive deficits. Ratios of antagonistic over agonistic muscle activation were similar between groups. Tracking errors increased trunk inclination, but no significant relation between tracking error and agonistic muscle activation was found. Tracking errors did not decrease when antagonistic muscle activation increased, so, neither healthy subjects nor LBP patients appear to counteract trunk movement errors by increasing co-contraction. © 2013 Elsevier B.V.


Kievit A.J.,University of Amsterdam | Jonkers F.J.,Center for Orthopaedic Research Alkmaar | Barentsz J.H.,Orthopedium Orthopedische Kliniek Delft | Blankevoort L.,University of Amsterdam
Arthroscopy - Journal of Arthroscopic and Related Surgery | Year: 2013

Purpose: The purpose of this study was to assess the degree of osteoarthritis, degree of laxity, and quality-of-life (QOL) scores in primary and revision anterior cruciate ligament (ACL) reconstruction. Methods: This was a cross-sectional study; 25 patients who had undergone revision ACL reconstruction with allografts were identified and compared with 27 randomly selected primary ACL reconstruction patients operated on in the same hospital in the same period with the same technique. The main outcome measure was the International Knee Documentation Committee (IKDC) radiographic osteoarthritis sum score, and secondary outcome measures were Knee injury and Osteoarthritis Outcome Score, IKDC functional outcome measures, anterior laxity, and QOL at follow-up. Results: The median follow-up was 5.3 years for revision reconstruction patients and 5.1 years for primary reconstruction patients. Radiographic IKDC sum scores for osteoarthritis were found to be significantly worse in revision patients, with a median of 4, compared with primary patients, with a median of 1 (P =.016). Differences were found in meniscal injury (P =.02) and cartilage status (P <.001) before or at the index operation. Significantly worse outcomes were found in the following subscores of the Knee injury and Osteoarthritis Outcome Score: pain (median, 92 v 97; P =.032), symptom (median, 86 v 96; P =.015), activities of daily living (median, 94 v 100; P =.020), sport (median, 50 v 85; P =.006), and QOL (median, 56 v 81; P =.001). IKDC functional outcome measures were the same in both groups except for the pivot-shift test (P =.007). No differences were found in anterior drawer, Lachman, or KT-1000 arthrometer (MEDmetric, San Diego, CA) testing. Present-day health scores on the EQ-5D were worse for revision reconstruction patients (median, 70 v 80; P =.009). Conclusions: Revision reconstruction patients have more signs of osteoarthritis and worse QOL than primary reconstruction patients, even though they have comparable IKDC success rates and KT-1000 arthrometer laxity test results. Level of Evidence: Level III, retrospective comparative study. © 2013 by the Arthroscopy Association of North America.


Kuiper J.W.P.,Center for Orthopaedic Research Alkmaar | Willink R.T.,University Hospitals Leuven | Moojen D.J.F.,University Hospitals Leuven | van den Bekerom M.P.J.,Onze Lieve Vrouwe Gasthuis | Colen S.,University Hospitals Leuven
World Journal of Orthopaedics | Year: 2014

Periprosthetic joint infection (PJI) is a devastating complication after total joint arthroplasty, occurring in approximately 1%-2% of all cases. With growing populations and increasing age, PJI will have a growing effect on health care costs. Many risk factors have been identified that increase the risk of developing PJI, including obesity, immune system deficiencies, malignancy, previous surgery of the same joint and longer operating time. Acute PJI occurs either postoperatively (4 wk to 3 mo after initial arthroplasty, depending on the classification system), or via hematogenous spreading after a period in which the prosthesis had functioned properly. Diagnosis and the choice of treatment are the cornerstones to success. Although different definitions for PJI have been used in the past, most are more or less similar and include the presence of a sinus tract, blood infection values, synovial white blood cell count, signs of infection on histopathological analysis and one or more positive culture results. Debridement, antibiotics and implant retention (DAIR) is the primary treatment for acute PJI, and should be performed as soon as possible after the development of symptoms. Success rates differ, but most studies report success rates of around 60%-80%. Whether single or multiple debridement procedures are more successful remains unclear. The use of local antibiotics in addition to the administration of systemic antibiotic agents is also subject to debate, and its pro's and con's should be carefully considered. Systemic treatment, based on culture results, is of importance for all PJI treatments. Additionally, rifampin should be given in Staphylococcal PJIs, unless all foreign material is removed. The most important factors contributing to treatment failure are longer duration of symptoms, a longer time after initial arthroplasty, the need for more debridement procedures, the retention of exchangeable components, and PJI caused by Staphylococcus (aureus or coagulase negative). If DAIR treatment is unsuccessful, the following treatment option should be based on the patient health status and his or her expectations. For the best functional outcome, one- or two-stage revision should be performed after DAIR failure. In conclusion, DAIR is the obvious choice for treatment of acute PJI, with good success rates in selected patients. © 2014 Baishideng Publishing Group Inc.

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