José Cordero-Ampuero

Fundación Jiménez Díaz, Madrid, Madrid, Spain

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Publications (22)38.11 Total impact

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    ABSTRACT: The role of economic resources, distribution of providers, and demography may explain part of the variability found in hip arthroplasty in international surveys. We aimed to investigate the influence of ageing index, health budget, and density of orthopaedic surgeons in the regional variability of the primary and revision THR rate in Spain, where regions decide on the allocation of their health budget. Inpatient database of hip procedures for years 1997 to 2011 was obtained from the Spanish Ministry of Health, segregated for each of the 17 regional health services in Spain. Crude and adjusted rates (direct method with total Spanish population per year) were calculated and used as dependent variables. Ageing index, Health Expenditure of Gross Domestic Product (GDP), and number of orthopaedic surgeons per region were used as independent variables. Negative binomial regression analysis model and Poisson regression were calculated to estimate the risk contribution of the ecological variables. A total of 425,914 hip procedures, with 367,489 primary (mean crude rate = 124 × 10<sup>5</sup> inhabitants/year) and 58,425 revision hips (21 × 10<sup>5</sup> inhabitants/year) were included in the analysis. Regional variability was higher than expected in THR in Spain, despite a universal coverage health system in which equity may be challenged in the administration of hip arthroplasty. This was found particularly for primary THR. When hip replacement rates were adjusted for sex and age, the regional ageing index, the density of orthopaedic surgeons and the regional health budget could only partially explain risk ratio changes.
    Hip international: the journal of clinical and experimental research on hip pathology and therapy 01/2014; · 0.34 Impact Factor
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    ABSTRACT: Prosthetic joint infections (PJIs) are related to the formation of biofilms, mainly by Staphylococcus aureus and Staphylococcus epidermidis. Therapy is usually selected according conventional susceptibility testing, but these data may be insufficient to detect the true antibiotic susceptibility in the biofilm. In total, 32 clinical strains (17 S. aureus and 15 S. epidermidis) isolated from patients with PJIs as well as 2 collection strains (S. aureus 15981 and S. epidermidis ATCC 35984) were tested against nine antibiotics commonly used in the treatment of PJIs (rifampicin, vancomycin, tigecycline, clindamycin, trimethoprim/sulfamethoxazole, ciprofloxacin, cloxacillin, daptomycin and fosfomycin) using the Calgary Biofilm Device. None of the antibiotics proved to be totally effective against biofilms in both species, with minimum biofilm eradication concentrations (MBECs) highly above the minimum inhibitory concentrations for most of the antibiotics (>1024mg/L). Rifampicin and tigecycline showed MBECs slightly lower, mainly against S. epidermidis biofilms, and only two strains of this staphylococcal species were susceptible to almost all of the antibiotics tested. These results show that the search for new compounds with antimicrobial and antibiofilm properties is mandatory as well as the development of other strategies that could lead to the prevention and treatment of PJIs. In addition, more studies are necessary to obtain a better understanding of the mechanisms involved in antimicrobial resistance of biofilms.
    International journal of antimicrobial agents 04/2013; · 3.03 Impact Factor
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    ABSTRACT: BACKGROUND AND PURPOSE: Geographic variations in knee arthroplasty have been detected through international surveys. We aim to investigate in this study the influence of aging index, health budget, and number of orthopedic surgeons in the regional variations of the primary and revision TKA rate in a single European country, Spain. MATERIAL AND METHODS: Inpatient database of knee arthroplasty procedures for years 1997 to 2010 was obtained from the Spanish Ministry of Health, including 393,714 primaries and 37,037 revisions, segregated for each of the 17 regional health services in Spain. Crude and adjusted rates (direct method with total Spanish population per year) were calculated and used as dependent variables. Aging index, regional health budget, and number of orthopedic surgeons per region were used as independent variables in a Kruskal-Wallis test and a negative binomial regression analysis model. RESULTS AND CONCLUSIONS: With a mean crude rate for Spain of 76 primary TKA and 7 revision surgeries per 10(5) population and year, the mean adjusted rate per region oscillated between 702 and 27 primary TKA and 87 and 3 revisions per 10(5). A model was adjusted confirming the influence of aging index, health budget, and number of surgeons, but regional variations remained partly unexplained by these factors.
    The Knee 03/2013; · 2.01 Impact Factor
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    ABSTRACT: BACKGROUND: In patients with asymptomatic bacteriuria undergoing hip arthroplasty, the risk of prosthetic joint infection (PJI) and appropriateness of specific antibiotics are unclear. QUESTIONS/PURPOSES: We determined (1) the prevalence of asymptomatic bacteriuria; and (2) the incidence of PJI in patients with asymptomatic bacteriuria managed with or without specific antibiotics. METHODS: We conducted a prospective, randomized study of all 471 patients without urinary symptoms receiving a total hip arthroplasty (THA; n = 228; average age 68 years; 122 female) or hemiarthroplasty (HA; n = 243; average age 85 years; 170 female) between April 2009 and November 2010. No patients were catheterized in the perioperative period and all received intravenous cefazolin (allergy, vancomycin) for 48 hours postoperatively. Urinalysis was conducted on all patients; if abnormal, a urine culture was performed. Patients with bacteriuria (> 100,000 colonies/mL cultured) were randomly assigned to receive specific antibiotics (Group A) or not (Group B). Minimum followup was 1 month including those six who died or were lost to followup (average, 10.4 months; range, 1-12 months). RESULTS: Asymptomatic bacteriuria occurred in eight of 228 patients undergoing THAs (three of eight with specific antibiotics) and 38 of 243 patients undergoing HAs (23 of 38 with specific antibiotics). Arthroplasty infection after 3 months occurred in one of 228 patients undergoing THAs and 12 of 243 patients undergoing HAs (six of 117 in Group A and six of 126 in Group B); bacteria cultured from the wound were dissimilar to those cultured in urine samples in any case. No patient presented signs of PJI by 1 year after the index surgery. CONCLUSIONS: We identified no case of PJI from urinary origin in patients with asymptomatic bacteriuria whether or not they had been treated with specific antibiotics. LEVEL OF EVIDENCE: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
    Clinical Orthopaedics and Related Research 02/2013; · 2.79 Impact Factor
  • José Cordero-Ampuero
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    ABSTRACT: Girdlestone is one of the options for treating an infected hip arthroplasty (along with isolated antibiotics, debridement, and one or two-stage exchange). The choice must be based on a list of previous considerations. Results of girdlestone: Major differences among different series are reported in literature: from 13% to 83% of patients are satisfied with the result. Healing of infection is attained in 80% to 100% of patients, but figures are worse in special subsets (rheumatoid arthritis, enterococcal and methicillin-resistant infections, or when cement is retained). Pain is reported as severe in 16% to 33% of patients, moderate in 24% to 53% and mild in 76%, while only some authors refer to "satisfactory pain relief". Up to 45% of geriatric patients are unable to walk and only 29% walk independently. The literature reports Harris Hip scores from 25 to 64. Indications for girdlestone: Absolute indications: non-ambulatory patients because of other problems or diseases, and impossible reimplantation (2nd-stage surgery) (unacceptable anaesthetic or surgical risk, technical difficulties, patient rejection). Relative indications: Dementia (risk of dislocation vs. severely reduced walking ability), immunocompromise (up to what degree of immune impairment do we accept to take the risk?), intravenous drug abuse (how can you prove it?).
    Hip international: the journal of clinical and experimental research on hip pathology and therapy 09/2012; 22 Suppl 8:36-9. · 0.34 Impact Factor
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    ABSTRACT: Prosthetic joint infections (PJI) are severe complications in Orthopedics, with Staphylococcus aureus and Staphylococcus epidermidis being the most commonly isolated pathogens. The variable antimicrobial susceptibility found in these microorganisms, along with the increasing number of methicillin-resistant strains, increases the difficulty of antibiotic selection and makes it necessary to perform individual susceptibility studies to select the optimal antibiotic treatment. The aim of this study was to evaluate the in vitro susceptibility pattern of 35 clinical strains isolated from PJI (17 S. aureus and 18 S. epidermidis) against rifampin, vancomycin, tygecicline, clindamycin, cotrimoxazole, cloxacillin, ciprofloxacin, daptomycin and fosfomycin. In vitro susceptibility assays were performed using the broth microdilution method and agar dilution for fosfomycin. MBC was also determined. Tygecicline and daptomycin showed the highest antimicrobial activity with low MIC(90) values, and no resistant strains were detected. On the other hand, ciprofloxacin and cloxacillin exhibited a poor antimicrobial effect with a high percentage of nonsusceptible strains in both species. Bactericidal activity rates revealed the bacteriostatic behavior of rifampin, tygecicline, cotrimoxazole, fosfomycin and clindamycin, whereas vancomycin and cloxacillin showed species- and strain-dependent behavior. Daptomycin and ciprofloxacin were observed to be efficient bactericidal agents against the tested strains. According to our data, rifampin, tigecycline, daptomycin and fosfomycin showed high in vitro activity against most staphylococcal strains isolated from the PJIs tested, although daptomycin seems to be the best alternative to vancomycin therapy.The Journal of Antibiotics advance online publication, 1 August 2012; doi:10.1038/ja.2012.62.
    The Journal of Antibiotics 08/2012; · 2.19 Impact Factor
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    ABSTRACT: We wanted to improve the diagnosis of implant-related infection using molecular biological techniques after sonication. We studied 258 retrieved implant components (185 prosthetic implants and 73 osteosynthesis implants) from 126 patients. 47 patients had a clinical diagnosis of infection (108 components) and 79 patients did not (150 components). The fluids from sonication of retrieved implants were tested in culture and were also analyzed using a modified commercial PCR kit for detection of Gram-positive and Gram-negative bacteria (GenoType BC; Hain Lifescience) after extraction of the DNA. 38 of 47 patients with a clinical diagnosis of infection were also diagnosed as being infected using culture and/or PCR (35 by culture alone). Also, 24 patients of the 79 cases with no clinical diagnosis of infection were identified microbiologically as being infected (4 by culture, 16 by PCR, and 4 by both culture and PCR). Comparing culture and PCR, positive culture results were obtained in 28 of the 79 patients and positive PCR results were obtained in 35. There were 21 discordant results in patients who were originally clinically diagnosed as being infected and 28 discordant results in patients who had no clinical diagnosis of infection. For prosthetic joint infections and relative to culture, molecular detection can increase (by one tenth) the number of patients diagnosed as having an infection. Positive results from patients who have no clinical diagnosis of infection must be interpreted carefully.
    Acta Orthopaedica 05/2012; 83(3):299-304. · 2.74 Impact Factor
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    ABSTRACT: Bacterial adherence on total joint replacement implants may lead to biofilm formation and implant-related osteoarticular infection. It is unclear if different biomaterials in the prosthetic components are more prone to facilitate this bacterial adherence, although ultrahigh molecular weight polyethylene (UHMWPE) component exchange in modular systems has been clinically utilized in the early management of these infections. To clarify if the amount of clinically adhered microorganisms was related to the material or the component, we investigated retrieved implants from infected joint replacements. Thirty-two patients were revised after confirmed implant-related infection through positive cultures. Eighty-seven total joint components (hip and knee) were obtained and separately sonicated following a previously published protocol. Cultures were quantified, and detected colony forming units (CFU) were adjusted according to the component surface and compared based on the component material and location. Variable adherence of bacteria to chrome cobalt alloys, UHMWPE, hydroxyapatite coated components, and titanium alloys. The commonest isolated organisms were Staphylococcus epidermidis (23 of 87 components) and Staphylococcus aureus (10 of 87). Twelve components did not show any microorganism adhered despite location in an infected joint, with positive cultures in other components. A mixed linear model adjusted for random effects (the random effect being the infected patient) obtained convergence for the CFU/mm(2) variable, but could not confirm a significantly higher adherence to a particular component or to a particular biomaterial. Therefore, the bacterial adherence primarily depends on the infective microorganism and the response of each individual patient, rather than materials or components.
    Journal of Orthopaedic Research 03/2012; 30(10):1634-9. · 2.88 Impact Factor
  • J. Cordero-Ampuero, A. Darder, J. Santillana, M.T. Caloto, G. Nocea
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    ABSTRACT: Objectives To establish a conceptual model that links arthritis, functional disability in activities of daily living, and quality of life (QoL).MethodsA multicentre, cross-sectional, observation study was performed. The location of the arthritis (presence/absence) was recorded. Disability was measured using the Health Assessment Questionnaire Disability Index and the QoL determined using the EQ-5D-3 Level questionnaire. The relationship between the arthritis, disability, and the QoL was evaluated using the structural equation model (SEM).ResultsPatients: 965 patients with arthritis (mean age=64 years, with 75% females). Arthritis: mean areas affected: 2.8. Areas most frequently affected: knees (67%); lumbar spine (60%) and cervical spine (45%). QoL: The majority of patients did not mention serious problems in the five domains assessed. Disability: «other activities» (mean=1.2); «reach» (mean=1.1) and «walking» (mean=1.0) were the categories that demonstrated greater disability. The SEM showed arthritis, disability and QoL as associated latent variables. Although 92% of the QoL explained the disability, only 5% of the disability was due to the presence/absence of arthritis. The global model that describes arthritis as a cause of disability, and disability was affecting the QoL, had a reasonable goodness of fit (CMIN/DF=5.42; RMR=0.026; RMSEA=0.069).Conclusions Functional disability can explain the decrease in QoL. In theory, arthritis is closely related with disability and QoL, but the model did not mange to fully explain this link. As statistical techniques required good measurement models to correctly determine relationships, conventional medical records seem to be insufficient for this purpose. Other valid measurements of arthritis are needed to provide tests of its direct effect on disability and QoL.
    Revista Española de Cirugía Ortopédica y Traumatología. 01/2012; 56(3):197–204.
  • J. Cordero-Ampuero, A. Darder, J. Santillana, M.T. Caloto, G. Nocea
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    ABSTRACT: Objectives To establish a conceptual model that links arthritis, functional disability in activities of daily living, and quality of life (QoL).MethodsA multicentre, cross-sectional, observation study was performed. The location of the arthritis (presence/absence) was recorded. Disability was measured using the Health Assessment Questionnaire Disability Index and the QoL determined using the EQ-5D-3 Level questionnaire. The relationship between the arthritis, disability, and the QoL was evaluated using the structural equation model (SEM).ResultsPatients: 965 patients with arthritis (mean age = 64 years, with 75% females). Arthritis: mean areas affected: 2.8. Areas most frequently affected: knees (67%); lumbar spine (60%) and cervical spine (45%). QoL: the majority of patients did not mention serious problems in the five domains assessed. Disability: “other activities” (mean = 1.2); “reach” (mean = 1.1) and “walking” (mean = 1.0) were the categories that demonstrated greater disability. The SEM showed arthritis, disability and QoL as associated latent variables. Although 92% of the QoL explained the disability, only 5% of the disability was due to the presence/absence of arthritis. The global model that describes arthritis as a cause of disability, and disability was affecting the QoL, had a reasonable goodness of fit (CMIN/DF = 5.42; RMR = 0.026; RMSEA = 0.069).Conclusions Functional disability can explain the decrease in QoL. In theory, arthritis is closely related with disability and QoL, but the model did not mange to fully explain this link. As statistical techniques required good measurement models to correctly determine relationships, conventional medical records seem to be insufficient for this purpose. Other valid measurements of arthritis are needed to provide tests of its direct effect on disability and QoL.ResumenObjetivosEstablecer un modelo conceptual que vincule la afectación artrósica, la discapacidad funcional en las actividades cotidianas y la calidad de vida (CdV).MétodosEstudio multicéntrico, observacional y transversal. Se registró clínicamente la afectación artrósica (presencia/ausencia), según la localización; se valoró la discapacidad mediante el índice de discapacidad del cuestionario de evaluación de la salud y se determinó la CdV mediante el cuestionario EQ-5D-3L. El vínculo entre la artrosis, la discapacidad y la CdV se evaluó mediante la modelización de ecuación estructural (SEM).ResultadosPacientes: 965 pacientes con artrosis (edad media = 64 años; 75% mujeres). Artrosis: zonas medias afectadas: 2,8. Zonas afectadas con más frecuencia: rodillas (67%); columna lumbar (60%) y cervical (45%). CdV: la mayoría de los pacientes no refirió problemas graves en los 5 dominios evaluados. Discapacidad: «otras actividades» (media = 1,2); «alcanzar» (media = 1,1) y «caminar» (media = 1,0) fueron las categorías que mostraron mayor discapacidad. La SEM presentó la artrosis, la discapacidad y la CdV como variables relacionadas latentes. Aunque el 92% de la CdV explicó la discapacidad, solo el 5% de la discapacidad se debió a la presencia/ausencia de artrosis. El modelo global que describió la artrosis como causante de discapacidad y discapacidad que afectaba a la CdV, tuvo un buen ajuste general (CMIN/DF = 5,42; RMR = 0,026; RMSEA = 0,069).ConclusionesLa discapacidad funcional puede explicar la disminución de la CdV. En teoría, la artrosis se relaciona estrechamente con la discapacidad y la CdV, pero el modelo no consiguió explicar por completo este vínculo. Como las técnicas estadísticas requieren buenos modelos de medición para determinar correctamente las relaciones, los registros clínicos convencionales parecen insuficientes para este propósito. Se precisan otras mediciones válidas de la afectación artrósica para proporcionar pruebas de su efecto directo en la discapacidad y la CdV.
    Revista Española de Cirugía Ortopédica y Traumatología (English Edition). 01/2012; 56(3):197–204.
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    ABSTRACT: Sonication is currently considered the best procedure for microbiological diagnosis of implant-related osteoarticular infection, but studies in nail-related infections are lacking. The study aim was to evaluate implant sonication after intramedullary nail explantation, and relate it to microbiological cultures and clinical outcome. A study was performed in two University Hospitals from the same city. Thirty-one patients with implanted nails were prospectively included, whether with clinical infection (8 cases) or without (23 cases). Retrieved nails underwent sonication according a previously published protocol. The clinical and microbiological outcome patient was related to the presence of microorganisms in the retrieved implant. Positive results appeared in 15/31 patients (9 with polymicrobial infections) almost doubling those clinically infected cases. The most commonly isolated organisms were Staphylococcus epidermidis (19.2 %) and Staphylococcus aureus (15.4 %). A significant relationship was found between the presence of positive cultures and previous local superficial infection (p=0.019). The presence of usual pathogens was significantly related to clinical infection (p=0.005) or local superficial infection (p=0.032). All patients with positive cultures showed pain diminution or absence of pain after nail removal (15/15), but this only occurred in 8 (out of 16) patients with negative cultures. In patients with previously diagnosed infection or local superficial infection, study of the hardware is mandatory. In cases where pain or patient discomfort is observed, nail sonication can help diagnose the implant colonization with potential pathogens that might require specific treatment to improve the final outcome.
    The Open Orthopaedics Journal 01/2012; 6:255-60.
  • J Cordero-Ampuero, A Darder, J Santillana, M T Caloto, G Nocea
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    ABSTRACT: To evaluate expectations regarding osteoarthritis (OA) treatment of patients (PT) and physicians (PH) (Orthopedic Surgeons) in Spain. Multicenter, cross-sectional study in adult patients with OA with at least 1 year of disease progression and with at least one prescription of anti-inflammatory drugs within the last year. Sociodemographic, clinical, and treatment characteristics as well as patient-reported outcomes were obtained by phone interview. Using a treatment expectations questionnaire and applying Kano methodology, treatment attributes were classified as: must-be; one-directional; attractive; indifferent; reverse or questionable. A total of 965 adult patients with OA [mean age: 64 years (SD: 11); 75% women] and 383 PH [mean age: 47 years (SD: 10); 14% women] were surveyed. None of the treatment attributes showed a dominant "must-be" characteristic. The attributes that led to a greater dissatisfaction when absent were non-occurrence of long-term adverse effects, no discomfort upon administration, and achievement of symptoms relief. The two attributes that were considered most important by PT were as follows: achievement of both total disappearance of the symptoms and lasting symptom relief. Conversely, for PH, the two most important attributes were related to short- and long-term safety. A clear different perspective regarding treatment expectation was noted among PT (effectiveness) and PH (safety). Therefore, when selecting the most appropriate treatment for OA, PH should invite PT to participate in the decision making.
    Quality of Life Research 12/2011; 21(8):1391-404. · 2.41 Impact Factor
  • Jaime Esteban, José Cordero-Ampuero
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    ABSTRACT: INTRODUCTION: Despite being relatively infrequent, prosthetic joint infections are a devastating medical complication. However, recent advances in surgical techniques, new antibiotics, and knowledge about pathogenic mechanisms have improved the outcome for affected patients. AREAS COVERED: We have analyzed recent advances in pathogenesis, medical and surgical therapy of prosthetic joint infections, with special focus on new antibiotics useful for this disease. Recent studies focused on the important role of biofilms and intracellular bacteria in the pathogenesis of biomaterial-related infections. These advances must guide the management of the patients. Together with more classical antibiotics, linezolid and daptomycin have shown their usefulness for the treatment of these infections. Recently developed lipoglycopeptides have the potential to be used for these infections. In this sense, the possibility of treating patients with oral antibiotics without lack of efficacy is of great interest. EXPERT OPINION: Individualized therapies that take into account the microbial etiology, pathogenesis of the disease, antimicrobial susceptibility, and efficacy of antibiotics against biofilms and intracellular organisms make it possible to treat even those infections caused by multidrug-resistant organisms. A multidisciplinary approach (including a surgeon, infectious diseases specialist and microbiologist) provides the best possible management of patients.
    Expert Opinion on Pharmacotherapy 03/2011; 12(6):899-912. · 2.86 Impact Factor
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    ABSTRACT: Tesis doctoral inédita leída en la Universidad Autónoma de Madrid, Facultad de Medicina. Departamento de Cirugía. Fecha de lectura: 19-Septiembre-2007
    01/2011;
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    ABSTRACT: Biofilms are considered the key factor in the development of implant-related infections. However, only a few reports have dealt with the ability of organisms isolated from such infections to develop biofilms in vitro. We evaluated different phenotypic techniques (2 microtiter plate assays and confocal laser scanning microscopy (CLSM) and genotypic techniques (detection of the ica operon) related to biofilm development by clinical isolates of Staphylococcus spp. All 26 strains tested (from 23 specimens) were biofilm producers. Stepanovic test detected biofilm formation in 85% of the strains, microtiter plate assay in 65%, and CLSM in 39%. The ica operon was detected in 73% of all strains (all 13 S. aureus strains and 6 of the 13 coagulase-negative Staphylococcus strains). 7 ica-negative strains were biofilm-positive by phenotypic methods. The detection of ica genes could not be related to the phenotypic ability of the strains to develop a biofilm in vitro, so both studies (genetic and phenotypic) are required for a better evaluation of the biofilm-producing ability of clinical strains of Staphylococcus isolated from orthopedic infections.
    Acta Orthopaedica 12/2010; 81(6):674-9. · 2.74 Impact Factor
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    José Cordero-Ampuero, Marisol de Dios
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    ABSTRACT: Late infection is the second most frequent early complication after total hip arthroplasty (THA) and the most frequent after hemiarthroplasty. Known risk factors for infection after THA include posttraumatic osteoarthritis, previous surgery, chronic liver disease, corticoid therapy, and excessive surgical time. However, risk factors for hemiarthroplasty are not clearly established. We therefore determined the preoperative and intraoperative risk factors for late infection (more than 3 months after surgery) in patients with hemiarthroplasties and THAs. We retrospectively compared 47 patients with a hip arthroplasty (23 hemiarthroplasties, 24 total hip arthroplasties) and late infection with 200 randomly-selected patients with primary arthroplasty (100 hemiarthroplasties, 100 total hip arthroplasties) during the same time period of time without any infection during followup. Potential risk factors were identified from medical records. Minimum followup was 12 months (mean, 27 months; range, 12-112 months) for the study group and 18 months (mean, 84 months; range, 18-144 months) for the control group. The following factors were more frequent in late infected hemiarthroplasties: female gender; previous surgery; obesity (body mass index greater than 30 kg/m(2)); glucocorticoid and immunosuppressant treatments; prolonged surgical time; inadequate antibiotic prophylaxis; prolonged wound drainage; hematoma; dislocation; and cutaneous, urinary, and/or abdominal infections. The following were more frequent in infected total hip arthroplasties: posttraumatic osteoarthritis; previous surgery; glucocorticoids; chronic liver disease; alcohol and intravenous drug abuse; prolonged surgical time; prolonged wound drainage; dislocation; subsequent surgery; and cutaneous, urinary, respiratory and abdominal infections. Diabetes did not appear to be a risk factor. Our data suggest there are specific risk factors for infection in hemiarthroplasties. The major risk factors for late infection in hip arthroplasty must be recognized so they can be minimized or controlled if not possible to employ prophylactic measures.
    Clinical Orthopaedics and Related Research 12/2010; 468(12):3268-77. · 2.79 Impact Factor
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    José Cordero-Ampuero, Jaime Esteban, Eduardo García-Rey
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    ABSTRACT: Previous studies of knee arthroplasty infections caused by high-virulence organisms suggest poor outcomes. Polymicrobial and Gram-negative infections are less studied. This study compared the results of treatment of knee arthroplasty infections by single versus polymicrobial isolates, Gram-positive versus Gram-negative, and methicillin-resistant versus -sensitive Staphylococci. We prospectively followed 47 patients with late knee arthroplasty infections. The mean age was 72 years (range, 20-87 years). The treatment protocol included two-stage exchange and a combination of two oral antibiotics given for 6 months. Minimum followup was 1 year (average, 4.8 +/- 3 years; range, 1-12 years). Control of the infection was judged by absence of clinical, serologic, and radiologic signs of infection. The functional outcome was evaluated by Knee Society score at the last followup. Infection was controlled in all 15 patients with polymicrobial and in 28 of 32 (88%) with monomicrobial infections, in eight of nine patients with Gram-negative and in 35 of 38 (92%) with Gram-positive isolates. Control was also achieved in 22 of 25 patients (88%) infected by methicillin-resistant Staphylococci and in 14 of 14 by methicillin-sensitive Staphylococci. The Knee Society scores averaged 81-63 in patients with polymicrobial infections and were higher than in monomicrobial infections (75-52). The mean KSS was 85-59 in Gram-negative infections compared to 75-55 in Gram-positive infections. The mean KSS was similar in methicillin-resistant (78-54) and methicillin-sensitive Staphylococci (73-56) infections. Polymicrobial and Gram-negative infections can be controlled in late knee arthroplasty infections. On the other hand, infections by methicillin-resistant Staphylococci are less likely to be controlled by the regimens we used. Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
    Clinical Orthopaedics and Related Research 05/2010; 468(5):1229-36. · 2.79 Impact Factor
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    José Cordero-Ampuero, Jaime Esteban, Eduardo García-Cimbrelo
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    ABSTRACT: Infected arthroplasties reportedly have a lower eradication rate when caused by highly resistant and/or polymicrobial isolates and in these patients most authors recommend intravenous antibiotics. We asked whether two-stage revision with interim oral antibiotics could eradicate these infections. We prospectively followed 36 patients (mean age, 71.8 years) with late hip arthroplasty infections. Combinations of oral antibiotics were prescribed according to cultures, biofilm, and intracellular effectiveness. The minimum followup was 1 year (mean, 4.4 years; range, 1-12 years). We presumed eradication in the absence of clinical, serologic, and radiographic signs of infection. Infection was eradicated in all 13 patients with highly resistant bacteria who completed a two-stage protocol (10 with methicillin-resistant Staphylococci) and in eight of 11 patients treated with only the first stage (and six of nine with methicillin-resistant Staphylococci). Infection was eradicated in six of six patients with polymicrobial isolates (of sensitive and/or resistant bacteria) who completed a two-stage protocol and in five of seven with polymicrobial isolates treated with only the first surgery. The Harris hip score averaged 88.1 (range, 70-98) in patients who underwent reimplantation and 56.8 (range, 32-76) in patients who underwent resection arthroplasty. Long cycles of combined oral antibiotics plus a two-stage surgical exchange appear a promising alternative for infections by highly resistant bacteria, methicillin-resistant Staphylococci, and polymicrobial infections.
    Clinical Orthopaedics and Related Research 04/2009; 467(9):2335-42. · 2.79 Impact Factor
  • E García-Rey, E García-Cimbrelo, J Cordero-Ampuero
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    ABSTRACT: We reviewed 111 hemispherical Duraloc series-500 acetabular components with a minimum follow-up of 12 years. The mean clinical and radiological follow-up was 13.4 years (12 to 15). A Profile hydroxyapatite-coated anatomical femoral component was used in each case. Six patients had a late dislocation, for whom the polyethylene liner was exchanged. Each acetabular component was well fixed and all femoral components showed signs of bone ingrowth. The mean rate of femoral head penetration was 0.10 mm/year (0.021 to 0.481). The probability of not developing femoral cortical hypertrophy and proximal osteopenia by 12 years was 80.2% (95% confidence interval, 72.7 to 87.6) and 77.5% (95% confidence interval, 69.7 to 85.2), respectively. Despite these good clinical results, further follow-up is needed to determine whether these prostheses will loosen with time.
    Journal of Bone and Joint Surgery - British Volume 04/2009; 91(3):327-32. · 2.69 Impact Factor
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    ABSTRACT: Exchange surgery in late arthroplasty infection is directed against bacteria adhering to implants. Therapies based on antibiotics that are effective intracellularly have been proposed recently. We have combined both strategies to improve the cure rate. 40 consecutive patients (16 hips, 24 knees) were diagnosed with late arthroplasty infection. The organisms isolated were 35 Staphylococcus, 19 of which were methicillin-resistant, 4 Enterococcus, 6 Gram-negative bacilli, and 4 Corynebacterium. The infections were managed by a combined therapy consisting of two-stage exchange surgery and two oral intracellularly-effective antibiotics. The antibiotics were selected according to bacterial sensitivity and intracellular and biofilm effectiveness. Second re-implantation surgery was delayed until clinical and analytical normalization. Patients were in hospital for only 1 week after each surgery, and were followed up prospectively on an outpatient basis (2-9 years). Cure of the infection was defined as absence of clinical, serological, and radiographic signs of infection during the whole follow-up. The infection was resolved in 38/40 patients (15/16 hips and 23/24 knees). Oral antibiotics that are effective intracellularly in combination with two-stage exchange surgery is a promising alternative for treating late arthroplasty infections. Oral antibiotics shorten hospitalization and reduce patient discomfort.
    Acta Orthopaedica 09/2007; 78(4):511-9. · 2.74 Impact Factor

Publication Stats

99 Citations
38.11 Total Impact Points

Institutions

  • 2010–2013
    • Fundación Jiménez Díaz
      • Servicio de Microbiología
      Madrid, Madrid, Spain
  • 2007–2013
    • Hospital Universitario de La Princesa
      Madrid, Madrid, Spain
  • 2010–2011
    • Universidad Autónoma de Madrid
      • Department of Medicine
      Madrid, Madrid, Spain
  • 2009
    • Hospital Universitario La Paz
      • Servicio de Cirugía Ortopédica y Traumatología
      Madrid, Madrid, Spain