@article{BoelchStreckPlumhoffetal.2020,
  author    = {Boelch, Sebastian Philipp and Streck, Laura Elisa and Plumhoff, Piet and Konrads, Christian and Gohlke, Frank and Rueckl, Kilian},
  title     = {Infection control and outcome of staged reverse shoulder arthroplasty for the management of shoulder infections},
  series = {JSES International},
  volume    = {4},
  journal   = {JSES International},
  doi       = {10.1016/j.jseint.2020.08.012},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-230620},
  pages     = {959-963},
  year      = {2020},
  abstract  = {Background The treatment of septic arthritis, caused by either hematogenous seeding, injections, or surgery, can be challenging. Staged reverse shoulder arthroplasty (RSA) with temporary implantation of an antibiotic-loaded spacer is widely accepted but still discussed controversially. This study investigated the shoulder-specific bacterial spectrum, infection control rate, functional outcome, and infection-free survival rate after staged RSA in the mid- to long-term follow-up. It was hypothesized that staged RSA would show a high infection-free survival rate. Methods A total of 39 patients treated with staged RSA for primary septic arthritis (n = 8), secondary infection (n = 8), or periprosthetic infection (n = 23) were retrospectively included. The infection control rate was calculated based on cultures taken intraoperatively at spacer removal and RSA implantation. Infection-free survival was defined as no revision due to infection. The minimum follow-up period for functional outcome assessment was 2 years (n = 14; mean, 76 months; range, 31-128 months). Results Cutibacterium (26\%) and coagulase-negative staphylococci (23\%) were the predominant pathogens. The infection control rate was 90\%. The cumulative infection-free survival rate was 91\% after 128 months. Follow-up examinations showed a mean Constant score of 48 (range, 7-85), a mean QuickDASH (short version of Disabilities of the Arm, Shoulder and Hand questionnaire) score of 40.0 (range, 11.4-93.3), and a mean pain score of 1.6 (range, 0-7). Conclusion Staged RSA implantation was confirmed to be a reliable treatment option for primary, secondary, and periprosthetic infections of the shoulder. The infection control rate and infection-free survival rate are satisfactory. However, patients and surgeons must be aware of functional impairment even after successful treatment of infections.},
  language  = {en}
}
@article{BoelchWeissenbergerSpohnetal.2018,
  author    = {Boelch, Sebastian Philipp and Weissenberger, Manuel and Spohn, Frederik and Rudert, Maximilian and Luedemann, Martin},
  title     = {Insufficient sensitivity of joint aspiration during the two-stage exchange of the hip with spacers},
  series = {Journal of Orthopedic Surgery and Research},
  volume    = {13},
  journal   = {Journal of Orthopedic Surgery and Research},
  number    = {7},
  doi       = {10.1186/s13018-017-0703-z},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-175576},
  year      = {2018},
  abstract  = {Background: Evaluation of infection persistence during the two-stage exchange of the hip is challenging. Joint aspiration before reconstruction is supposed to rule out infection persistence. Sensitivity and specificity of synovial fluid culture and synovial leucocyte count for detecting infection persistence during the two-stage exchange of the hip were evaluated. Methods: Ninety-two aspirations before planned joint reconstruction during the two-stage exchange with spacers of the hip were retrospectively analyzed. Results: The sensitivity and specificity of synovial fluid culture was 4.6 and 94.3\%. The sensitivity and specificity of synovial leucocyte count at a cut-off value of 2000 cells/μl was 25.0 and 96.9\%. C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) values were significantly higher before prosthesis removal and reconstruction or spacer exchange (p = 0.00; p = 0.013 and p = 0.039; p = 0.002) in the infection persistence group. Receiver operating characteristic area under the curve values before prosthesis removal and reconstruction or spacer exchange for ESR were lower (0.516 and 0.635) than for CRP (0.720 and 0.671). Conclusions: Synovial fluid culture and leucocyte count cannot rule out infection persistence during the two-stage exchange of the hip.},
  language  = {en}
}
@article{BoelchJakuscheitDoerriesetal.2018,
  author    = {Boelch, S. P. and Jakuscheit, A. and Doerries, S. and Fraissler, L. and Hoberg, M. and Arnholdt, J. and Rudert, M.},
  title     = {Periprosthetic infection is the major indication for TKA revision - experiences from a university referral arthroplasty center},
  series = {BMC Musculoskeletal Disorders},
  volume    = {19},
  journal   = {BMC Musculoskeletal Disorders},
  number    = {395},
  doi       = {10.1186/s12891-018-2314-1},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-176983},
  year      = {2018},
  abstract  = {Background: We hypothesized, that periprosthetic joint infection (PJI) accounts for the major proportion of first (primary) and repeated (secondary) Total Knee Arthroplasty revisions at our university referral arthroplasty center. Methods: One thousand one hundred forty-three revisions, performed between 2008 and 2016 were grouped into primary (55\%) and secondary (45\%) revisions. The rate of revision indications was calculated and indications were categorized by time after index operation. The odds ratios of the indications for primary versus secondary revision were calculated. Results: In the primary revision group PJI accounted for 22.3\%, instability for 20.0\%, aseptic loosening for 14.9\% and retropatellar arthrosis for 14.2\%. PJI (25.6\%) was the most common indication up to 1 year after implantation, retropatellar arthrosis (26.8\%) 1-3 years and aseptic loosening (25.6\%) more than 3 years after implantation. In the secondary revision group PJI accounted for 39.7\%, aseptic loosening for 16.2\% and instability for 13.2\%. PJI was the most common indication at any time of revision with 43.8\% up to one, 35.4\% 1-3 years and 39.4\% more the 3 years after index operation. The odds ratios in repeated revision were 2.32 times higher (p = 0.000) for PJI. For instability and retropatellar arthrosis the odds ratios were 0.60 times (p = 0.006) and 0.22 times (p = 0.000) lower. Conclusions: PJI is the most common indication for secondary TKA revision and within one year after primary TKA. Aseptical failures such as instability, retropatellar arthrosis and aseptical loosening are the predominant reasons for revision more than one year after primary TKA.},
  language  = {en}
}
@article{vonHertzbergBoelchLuedemannRudertetal.2022,
  author    = {von Hertzberg-Boelch, Sebastian Philipp and Luedemann, Martin and Rudert, Maximilian and Steinert, Andre F.},
  title     = {PMMA bone cement: antibiotic elution and mechanical properties in the context of clinical use},
  series = {Biomedicines},
  volume    = {10},
  journal   = {Biomedicines},
  number    = {8},
  issn      = {2227-9059},
  doi       = {10.3390/biomedicines10081830},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-281708},
  year      = {2022},
  abstract  = {This literature review discusses the use of antibiotic loaded polymethylmethacrylate bone cements in arthroplasty. The clinically relevant differences that have to be considered when antibiotic loaded bone cements (ALBC) are used either for long-term implant fixation or as spacers for the treatment of periprosthetic joint infections are outlined. In this context, in vitro findings for antibiotic elution and material properties are summarized and transferred to clinical use.},
  language  = {en}
}
@phdthesis{Emge2011,
  author    = {Emge, Karoline},
  title     = {Wertigkeit der Power-Doppler Sonographie bei der Erkennung von periprothetischen Infektionen},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-66194},
  school      = {Universit{\"a}t W{\"u}rzburg},
  year      = {2011},
  abstract  = {Ziel dieser Studie war die Beurteilung der diagnostischen Wertigkeit der PDS bei endoprothetischen Wechseloperationen von H{\"u}ft- und Kniegelenk. Dabei stand im Vordergrund die vergleichende Betrachtung der Darstellung der periprothetischen Synovialitis mittels PDS, der histologischen Beurteilung entsprechend der Konsensus-Klassifikation nach Morawietz und der Hygiene. Ein weiterer Aspekt war die Pr{\"u}fung der Reliabilit{\"a}t der neu etablierten Konsensus- Klassifikation nach Morawietz. Es wurden dazu 83 Patienten, 33 M{\"a}nner und 50 Frauen, mit einem Durchschnittsalter von 70 Jahren (43 - 88 Jahre) jeweils vor endoprothetischer Revision mittels PDS untersucht sowie eine pr{\"a}operative Labordiagnostik und intraoperative Probenentnahme zur Bestimmung der Hygiene und histologischen Beurteilung nach Morawietz durchgef{\"u}hrt. Es folgte ein Vergleich der PDS mit den Ergebnissen aus der Histologie und den intraoperativ gewonnenen Hygienebefunden. In dieser Studie zeigte sich keine signifikante Korrelation zwischen der PDS und den histologischen Ergebnissen. Auch konnte kein signifikanter Zusammenhang zwischen der PDS und Infektionen mit septischer Genese (intraoperativer Keimnachweis, erh{\"o}hte Entz{\"u}ndungsparameter) ermittelt werden. Somit erweist sich in dieser Studie, dass die PDS keinen geeigneten Beitrag im Verfahren zur pr{\"a}operativen Diagnostik von endoprothetischen Revisionen liefert. Am h{\"o}chsten fiel der positive Pr{\"a}diktivwert in unserer Studie beim Vergleich von histologischen Ergebnissen und mikrobiologischen Ergebnissen aus. Eine Untersuchung zum Einsatz von kontrastmittel-verst{\"a}rkter PDS in der Beurteilung von endoprothetischen Revisionen w{\"a}re sinnvoll. Nahezu identische Ergebnisse brachte der Vergleich unserer histopathologischen Daten der Konsensus-Klassifikation mit den von Morawietz et al. publizierten Daten. Diese Ergebnisse sprechen f{\"u}r eine gute Festlegung der Kriterien von Morawietz et al. und damit einer reliablen Methode zur histopathologischen Auswertung der Synovialmembran.},
  subject      = {Doppler-Sonographie},
  language  = {de}
}