Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Prosthesis Failure”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 523 records · Page 29Linked to original sources
PubMed2003

Positive leukocyte and negative bone scintigraphy in extensive arthroplasty infection.

An 85-year-old male resident of a nursing home presented after a fall with a painful left hip, confusion, and fever. He had multiple medical problems including severe vascular disease and poor vision as a result of macular degeneration. An Austin Moore left hip prosthesis had been inserted for a fractured femoral neck several years before. A septic workup showed a raised leukocyte count but no other focal abnormality. Plain radiography showed a periprosthetic fracture of the left hip. Blood cultures grew beta-hemolytic group A Streptococcus sensitive to penicillin. Bone scintigraphy was thought to be consistent with loosening of the prosthesis without evidence of a recent fracture. Tc-99m leukocyte scintigraphy was markedly abnormal, with extensive soft-tissue uptake suggestive of a large periprosthetic infective collection. This was confirmed at surgery with drainage of 200 mL pus from the left hip, and deep and superficial soft tissues of the thigh. The trochanteric fracture was well granulated and thought to be of long standing. The prosthesis was removed and the patient was treated with appropriate antibiotics with good effect.

Aged↗
PubMed2006

Corrosion and late infection causing delayed paraparesis after spinal instrumentation.

A 28-year-old female patient came to our hospital 14 years after surgical correction of adolescent idiopathic scoliosis with a 316L stainless-steel instrumentation. She presented progressive paraparesis during the last 2 months. Plain radiography, computed tomography scan and computed tomography-scan-guided needle biopsy revealed that a metallotic mass penetrated into the spinal canal, causing compression of the spinal cord at the T5-T6 level. The patient's symptoms were related to corrosion of the implant and infection by Propionibacterium acnes. Through a posterior approach, the instrumentation was retrieved and the metallotic mass and tissues were excised. Six months after the surgery, the patient is completely asymptomatic. Corrosion of stainless-steel implants is a finding more common than supposed. Biocorrosion--or microbially influenced corrosion--is a concept to be taken into account. It is possible that bacteria may modify the rate of corrosion of metals. Early diagnosis of corrosion is essential in order to prevent cases like the one we report, and perhaps, as suggested for total hip arthroplasties, metal levels could be useful to monitor spinal implants.

Adult↗
PubMed2006

Total joint replacement surgery in a rural centre.

OBJECTIVE: To demonstrate that total joint replacement surgery can be safely and effectively performed in rural hospitals with acceptable outcomes. DESIGN: Case series. SETTING: A rural district hospital. PARTICIPANTS: PARTICIPANTS were 64 patients, 30 men and 34 women, who underwent total knee replacements (TKR); and 63 patients, 41 men and 22 women, who had total hip replacements (THR). MAIN OUTCOME MEASURES: Level of patient satisfaction following total joint replacement surgery, obtained by patient interview. Incidence of postoperative joint specific complications, for example infection, THR dislocation and manipulation under anaesthetic (MUA) of a TKR. RESULTS: None of the TKR or THR patients developed a deep wound infection. In this study 8.8% TKR patients had an MUA but all during a period of limited physiotherapy services; 5.8% THR patients suffered a dislocated prosthesis. Following TKR 95.3% patients reported to be 'happy' with the outcome of their surgery. Of the THR patients 97.0% declared they were 'happy' with their surgical outcome. CONCLUSIONS: There was a high level of patient satisfaction, low infection rate, acceptable levels of MUA for TKR and dislocation for THR following total joint replacement in our rural district hospital. The surgeons performed a medium volume of total joint replacements and an appropriate multidisciplinary team was in place. In such settings joint replacement surgery can be safely and successfully performed in rural centres to the benefit of rural patients, surgeons and GPs.

Aged↗
PubMed2004

Successful antimicrobial therapy and implant retention for streptococcal infection of prosthetic joints.

BACKGROUND: Streptococci cause up to 20% of prosthetic joint infections but this has received little attention in the published literature. METHODS: We reviewed retrospectively our experience with treatment of streptococcal prosthetic joint infections. Patients were followed up for up to 15 years after discontinuation of antimicrobial therapy and up to 8.5 years while on continuous antimicrobial therapy. RESULTS: Eighteen cases were diagnosed between 1984 and 1995. These included one group A, seven group B, one group D, seven group G and one viridans-group streptococcal infection as well as one group B and D streptococcal co-infection. All were late-onset infections and most (11 of 18, 61%) were acute. Hip and knee joints were equally affected. Six of seven group G streptococcal infections were associated with skin or soft tissue infections. Sixteen patients were treated primarily with antimicrobial agents including 5 days to 6 weeks given intravenously and 2 weeks to 8.5 years given orally. At latest follow up, 10 patients had been off antimicrobial therapy for at least 18 months without relapse, one patient had been off antimicrobial therapy for 7 months without relapse and four infections were successfully controlled with long-term suppressive antimicrobial therapy. One infection was unable to be controlled with antimicrobial therapy. CONCLUSIONS: Our results, and those of others, show that prosthetic joint infections caused by streptococci have a relatively good outcome with primary antimicrobial therapy and, when necessary, drainage, lavage or debridement. Provided the prosthesis is stable and the patient can tolerate long-term antimicrobial therapy, this may be an effective alternative to excision arthroplasty.

Adult↗
PubMed1994

Reducing the loss of implants following penile prosthetic surgery.

OBJECTIVE: To assess the factors associated with loss of implant following penile prosthetic surgery and to make alterations in the management of patients to prevent this from occurring. PATIENTS AND METHODS: A retrospective analysis was carried out of the factors associated with post-operative infection and erosion in 188 patients who underwent implantation of penile prostheses. A prospective study was then established in which 62 patients were managed by a set protocol designed to counteract the factors identified as being contributory to loss of implants in the retrospective review. RESULTS: In the retrospective study nine (4.8%) patients lost a prosthesis due to erosion. Erosion was noted to be more common with one type of implant which has since been modified. Infection was the cause of prosthesis loss in 12.2% of patients in the retrospective review. The new protocol resulted in a significantly reduced infection rate in penile prostheses to 1.6% (P < 0.05). CONCLUSION: With attention to simple antiseptic prophylaxis, antibiotic penetration and continuing audit, a significant improvement in the loss of penile prostheses can be achieved along with a reduction in the amount of antibiotics prescribed.

Adult↗
PubMed1999

Complications related to permanent pacemaker therapy.

This study evaluates complications related to permanent endocardial pacing in the era of modern pacemaker therapy. There is only limited information available about the complications related to modern cardiac pacing. Most of the existing data are based on the 1970s and are no longer valid for current practice. The recent reports on pacemaker complications are focused on some specific complication or are restricted to early complications. Thus, there are no reports available providing a comprehensive view of complications related to modern cardiac pacing. Four hundred forty-six patients, who received permanent endocardial pacemakers between January 1990 and December 1995 at Kuopio University Hospital, were reviewed retrospectively using patient records. Attention was paid to the occurrence of any complication during the implantation or follow-up. An early complication was detected in 6.7%, and 4.9% of patients were treated invasively due to the early complication. Late complication developed in 7.2% and reoperation was required in 6.3% of the patients. Complications related to the implantation procedure occurred in 3.1%. Inadequate capture or sensing was observed in 7.4% of the patients. Pacemaker infection was detected in 1.8% and erosion in 0.9% of the patients. An AV block developed in 3.6% (1.6%/year) patients who received an AAI(R)-pacemaker due to sick sinus syndrome. There was no mortality attributable to pacemaker therapy. A great majority (68%) of the complications occurred within the first 3 months after the implantation. Complications associated to modern permanent endocardial pacemaker therapy are not infrequent. Eleven percent of patients needed an invasive procedure due to an early or late complication.

Adolescent↗
PubMed2006

Successful laser-assisted removal of an infected ICD lead with a large vegetation.

Infective endocarditis involving transvenous pacing leads is an uncommon but potentially lethal complication of implantable cardioverter-defibrillator (ICD) implantation. Complete removal of the device and the leads is presently considered to be the optimal treatment in such patients and laser-assisted lead removal is an effective and safe nonthoracotomy approach. However, large vegetations (>10 mm) attached to the lead limit nonthoracotomy explantation because of the potential for hemodynamically embarrassing pulmonary embolization. Laser extraction of leads with vegetation area >300 mm2 has rarely been reported. In this case report, we describe a patient with an infected ICD lead with vegetation greater than 41 x 12.5 mm (512 mm2) in size that was explanted with laser-assistance. The resulting pulmonary embolus produced a 33 x 20 mm pulmonary infarction without hemodynamic or respiratory compromise.

Defibrillators, Implantable↗
PubMed1990

Doppler echocardiography assessment of prosthetic heart valves.

Transthoracic Doppler echocardiography is an accurate noninvasive method for the evaluation of prosthetic valve function. The flow characteristics and pressure gradients of normally functioning mechanical and bioprosthetic valves have been, in general established. Normal functioning mitral valve prostheses have a valve area greater than 1.8 cm 2 with the St. Jude valve having the largest effective valve area and normally functioning aortic prosthetic valves have a peak instantaneous gradient of less than 45 mmHg, with the Starr-Edwards valves (Starr-Edwards, Irvine CA) showing the highest gradients. The incidence of minimal or mild regurgitation is approximately 15% to 30% in the mitral position and 25% to 50% in the aortic position, with the higher incidence of regurgitation seen with mechanical compared to bioprosthetic valves. Transthoracic Doppler echocardiography can accurately detect patients with prosthetic valvular stenosis. The presence of prosthetic aortic regurgitation can also generally be accurately assessed, except in the presence of both prosthetic aortic and mitral valves. Assessment of prosthetic mitral regurgitation remains limited due to significant attenuation of the ultrasound beam by the prosthesis and the frequent underestimation of severity of regurgitation. Other limitations of transthoracic studies include assessment of leaflet morphology, detection of vegetations and valve abscesses, and differentiation between valvular and paravalvular regurgitation.

Bioprosthesis↗
PubMed1993

Pitfalls in the echo-Doppler diagnosis of prosthetic valve disorders.

Assessment of artificial heart valves is a classic example of pitfalls in Doppler and color flow echocardiography. These limitations should be analyzed in the context of the most common clinical conditions associated with prosthetic valve dysfunction, that is, assessment of stenosis, regurgitation, endocarditis, and source of emboli. Estimation of the mean transvalvular gradient in addition to valve areas may avoid potential problems of over- or underestimation of stenotic lesions. The combination of acoustic attenuation, acoustic shadowing, and jet(s) eccentricity makes accurate grading of prosthetic regurgitation difficult and often frustrating. Reverberations and side lobe are frequent artifacts that decrease the ability of two-dimensional echocardiography to identify endocarditis-induced lesions such as vegetations and abscesses, as well as potential sources of emboli such as thrombus and atrial septal abnormalities. Transesophageal echocardiography has provided a new window in the evaluation of prosthetic cardiac valve function. With this approach, high frequency, high resolution transducers greatly improve the quality of ultrasound and color flow Doppler images that result in a higher diagnostic yield. In patients with suspected mitral prosthesis malfunction, transesophageal echocardiography is the method of choice. Contrast study during the transesophageal examination increases the sensitivity to detect potential sources of emboli such as patent foramen ovale. The improvement in diagnostic accuracy may allow one to avoid further diagnostic tests and, in selected patients, it may facilitate optimal timing of a surgical intervention.

Echocardiography, Doppler↗
PubMed1992

Cardiac surgery in patients with human immunodeficiency virus infection: indications and results.

Ten patients with human immunodeficiency virus (HIV) infections underwent cardiac surgery using cardiopulmonary bypass. All were in Centers for Disease Control (CDC) group II. The cardiac involvement was either urgent or severely symptomatic in all cases. One patient died due to acquired immunodeficiency syndrome (AIDS) unrelated cause. No complications were encountered in this series. Eight of the nine survivors were available for follow-up. Three of these eight patients progressed to AIDS (CDC group IV) and subsequently died. Five patients are alive and in CDC group II. Prognosis of the HIV infection and the natural history of the cardiac disease are the two main elements to be considered whenever cardiac surgery is required.

Acquired Immunodeficiency Syndrome↗
PubMed2005

Temporary hemodialysis catheters as a long-term vascular access in chronic hemodialysis patients.

The objective was to review our experience with temporary, precurved, jugular catheters used for long-term vascular access in chronic hemodialysis patients. Thirty chronic hemodialysis patients, 14 men and 16 women, with an average age of 65.3 +/- 13.5 years (30-90 years), treated by dialysis for 1 month to 30 years (average +/- SD, 6.3 +/- 8.1 years), had single lumen, 'temporary' precurved non-tunneled jugular catheters placed into the right jugular vein as permanent vascular access, with 4% trisodium citrate as a locking solution and mupirocin at the exit site. Hemodialysis catheters were used for vascular access on average for 9.1 +/- 6.5 months, (1-22.7 months), and for a total of 271.7 months (8151 days). Average catheter functioning time was 3.1 +/- 1.9 months (0.5-10 months). The total number of side-effects was 55 (6.7/1000 catheter days), including 26 cases of thrombosis (3.2/1000 catheter days), 9 ruptures of the catheter (1.1/1000 catheter days), 15 catheter malfunctions (1.8/1000 catheter days), 2 exit site infections (0.2/1000 catheter days), 2 bacteremias (0.2/1000 catheter days), 1 avulsion of the catheter (0.1/1000 catheter days), and 2 catheters were removed because an AV fistula was successfully used. In 21 patients single-needle hemodialysis was performed, mean blood flow 251 +/- 16 mL/min (250-300), mean Kt/V 0.96 +/- 0.16 (0.72-1.27) and in 9 patients double-needle hemodialysis was performed (catheter and peripheral vein) with mean blood flow 252 +/- 14 mL/min (200-300), mean Kt/V 1.63 +/- 0.25 (1.21-1.96). 'Temporary' jugular single lumen non-tunneled hemodialysis catheters, with 4% citrate as locking solution and mupirocin ointment at the exit site provided good long-term vascular access with acceptable functioning time and low infection rate. The main reasons for catheter exchange or removal were malfunction and mechanical damage of the catheter.

Adult↗
PubMed1993

Additional value of biplane transoesophageal imaging in assessment of mitral valve prostheses.

OBJECTIVES: To determine whether biplane transoesophageal imaging offers advantages in the evaluation of mitral prostheses when compared with standard single transverse plane imaging or the precordial approach in suspected prosthetic dysfunction. DESIGN: Prospective mitral valve prosthesis in situ using precordial and biplane transoesophageal ultrasonography. SETTING: Tertiary cardiac referral centre. SUBJECTS: 67 consecutive patients with suspected dysfunction of a mitral valve prosthesis (16 had bioprostheses and 51 mechanical prostheses) who underwent precordial, transverse plane, and biplane transoesophageal echocardiography. Correlative invasive confirmation from surgery or angiography, or both, was available in 44 patients. MAIN OUTCOME MEASURES: Number, type, and site of leak according to the three means of scanning. RESULTS: Transverse plane transoesophageal imaging alone identified all 31 medial/lateral paravalvar leaks but only 24/30 of the anterior/posterior leaks. Combining the information from both imaging planes confirmed that biplane scanning identified all paravalvar leaks. Five of the six patients with prosthetic valve endocarditis, all three with valvar thrombus or obstruction, and all three with mitral annulus rupture were diagnosed from transverse plane imaging alone. Longitudinal plane imaging alone enabled diagnosis of the remaining case of prosthetic endocarditis and a further case of subvalvar pannus formation. CONCLUSIONS: Transverse plane transoesophageal imaging was superior to the longitudinal imaging in identifying medial and lateral lesions around the sewing ring of a mitral valve prosthesis. Longitudinal plane imaging was superior in identifying anterior and posterior lesions. Biplane imaging is therefore an important development in the study of mitral prosthesis function.

Adult↗
PubMed2006

Proposal for a histopathological consensus classification of the periprosthetic interface membrane.

AIMS: The introduction of clearly defined histopathological criteria for a standardised evaluation of the periprosthetic membrane, which can appear in cases of total joint arthroplasty revision surgery. METHODS: Based on histomorphological criteria, four types of periprosthetic membrane were defined: wear particle induced type (detection of foreign body particles; macrophages and multinucleated giant cells occupy at least 20% of the area; type I); infectious type (granulation tissue with neutrophilic granulocytes, plasma cells and few, if any, wear particles; type II); combined type (aspects of type I and type II occur simultaneously; type III); and indeterminate type (neither criteria for type I nor type II are fulfilled; type IV). The periprosthetic membranes of 370 patients (217 women, 153 men; mean age 67.6 years, mean period until revision surgery 7.4 years) were analysed according to the defined criteria. RESULTS: Frequency of histopathological membrane types was: type I 54.3%, type II 19.7%, type III 5.4%, type IV 15.4%, and not assessable 5.1%. The mean period between primary arthroplasty and revision surgery was 10.1 years for type I, 3.2 years for type II, 4.5 years for type III and 5.4 years for type IV. The correlation between histopathological and microbiological diagnosis was high (89.7%), and the inter-observer reproducibility sufficient (85%). CONCLUSION: The classification proposed enables standardised typing of periprosthetic membranes and may serve as a tool for further research on the pathogenesis of the loosening of total joint replacement. The study highlights the importance of non-infectious, non-particle induced loosening of prosthetic devices in orthopaedic surgery (membrane type IV), which was observed in 15.4% of patients.

Adult↗
PubMed1999

An assessment of the histological criteria used to diagnose infection in hip revision arthroplasty tissues.

AIM: To characterise the number and nature of the inflammatory cells seen in cases of septic or aseptic loosening of hip arthroplasty, and to establish reliable histological criteria to distinguish between these two conditions. METHODS: Histological examination of paraffin sections of periprosthetic tissues (pseudocapsule, femoral and acetabular pseudomembranes) of 523 cases of aseptic loosening and 79 cases of microbiology culture proven septic loosening. The cellular composition of the inflammatory cell infiltrate was determined semiquantitatively. RESULTS: The finding of a 2+ or greater neutrophil polymorph infiltrate (one or more cells per high power field (x400) on average after examination of 10 fields) in arthroplasty tissues correlated strongly with the microbiological diagnosis of septic loosening: diagnostic sensitivity 100%, specificity 97%, accuracy 99%, positive predictive value 92%, negative predictive value 100%. The finding of a 3+ neutrophil polymorph infiltrate (five or more cells on average per high power field) had a diagnostic sensitivity of 72%, specificity 100%, accuracy 98%, positive predictive value 100%, and negative predictive value 97%. In some cases of septic loosening the finding of a heavy lymphocytic and plasma cell infiltrate was of low diagnostic sensitivity. A neutrophil polymorph infiltrate (generally less than one cell per 10 high power fields) was also seen in cases of aseptic loosening. CONCLUSIONS: The presence of 2+ or more (more than one neutrophil polymorph per high power field (x400) on average after examination of at least 10 high power fields) in periprosthetic tissues provides the most sensitive and accurate histopathological criterion for distinguishing between septic and aseptic loosening of hip arthroplasty.

Arthroplasty, Replacement, Hip↗