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69
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Introduction
Additional affiliations
June 2001 - present
Position
- Orthopaedic Surgeon staff
Description
- Reconstructive and Septic Surgery Unit
Publications
Publications (69)
We aim to evaluate the epidemiology and outcome of gram-negative prosthetic joint infection (GN-PJI) treated with debridement, antibiotics, and implant retention (DAIR), identify factors predictive of failure, and determine the impact of ciprofloxacin use on prognosis. We performed a retrospective, multicenter, observational study of GN-PJI diagnos...
Industrially preformed antibiotic-loaded cement spacers are useful to facilitate the second stage of two-stage exchange arthroplasty for infected THAs and TKAs. However, whether gentamicin alone or a combination of antibiotics (such as vancomycin and gentamicin) is more effective is not known.
We therefore sought to compare industrially prefabricat...
To investigate the clinical efficacy and safety of daptomycin in the treatment of hip and knee periprosthetic joint infections (PJIs).
We completed a retrospective review of all patients in our institution (n=20) who were treated with daptomycin for hip or knee PJI, over the 36 month period from January 2008 until December 2010.
Infection types inc...
Prosthetic joint infection (PJI) is a devastating complication after total hip arthroplasty. Its management consists of both: a radical debridement and implant retention or exchange (depending on the timing of symptoms) and directed antibiotic therapy. Thus, the isolation of atypical microorganisms implies a challenge, where anaerobes are responsib...
Purpose
Surgical approach can impact the reliability of the debridement after a chronic total knee periprosthetic joint infection (PJI), a factor of utmost importance to eradicate the infection. The most adequate knee surgical approach in cases of PJI is a matter of debate. The purpose of this study was to determine the influence of performing a ti...
Introduction
: Acute tibial fracture-related infection (FRI) is one of the most feared and challenging complications after a tibial fracture. The most appropriate treatment in this scenario is far from a resolved topic. Circular external fixators (CEFs) offer multiplanar control and minimize soft tissue injury using temporary implants far from the...
Purpose
Use of prefabricated mobile spacers in end-stage cases of hip periprosthetic joint infection (HPJI) is hindered when large bone defects exist. In such cases, prefabricated custom-made antibiotic spacers (P-CMAS) offer an alternative. Such spacers are individually designed according to the size and anatomical characteristics of the bone defe...
Aims
The aim of this study was to analyze the prevalence of culture-negative periprosthetic joint infections (PJIs) when adequate methods of culture are used, and to evaluate the outcome in patients who were treated with antibiotics for a culture-negative PJI compared with those in whom antibiotics were withheld.
Methods
A multicentre observationa...
Introduction
Managing critical-sized tibial defects is one of the most complex challenges orthopedic surgeons face. This is even more problematic in the presence of infection and soft-tissue loss. The purpose of this study is to describe a comprehensive three-stage surgical protocol for the reconstruction of infected tibial injuries with combined b...
PurposeTo evaluate preoperative asymptomatic bacteriuria (ASB) treatment to reduce early-periprosthetic joint infections (early-PJIs) after hip hemiarthroplasty (HHA) for fracture.Methods
Open-label, multicenter RCT comparing fosfomycin-trometamol versus no intervention with a parallel follow-up cohort without ASB. Primary outcome: early-PJI after...
Candida periprosthetic joint infection (CPJI) is a rare and very difficult to treat infection, and high-quality evidence regarding the best management is scarce. Candida spp. adhere to medical devices and grow forming biofilms, which contribute to the persistence and relapse of this infection. Typically, CPJI presents as a chronic infection in a pa...
We review antibiotic and other prophylactic measures to prevent periprosthetic joint infection (PJI) after hip hemiarthroplasty (HHA) surgery in proximal femoral fractures (PFFs). In the absence of specific guidelines, those applied to these individuals are general prophylaxis guidelines. Cefazolin is the most widely used agent and is replaced by c...
Epithelioma cuniculatum is characterized as a slow growing lesion on the sole of the foot. A diagnosis is usually delayed by a low clinical suspicion and misdirection due to its similarity to an infection. This tumor rarely metastasize but a local invasion of adjacent soft tissues is common, requiring ample surgical resection or even amputation in...
Epithelioma cuniculatum is characterized as a slow growing lesion on the sole of the foot. A diagnosis is usually delayed by a low clinical suspicion and misdirection due to its similarity to an infection. This tumor rarely metastasize but a local invasion of adjacent soft tissues is common, requiring ample surgical resection or even amputation in...
Purpose: To evaluate preoperative asymptomatic bacteriuria (ASB) treatment on the reduction of early-periprosthetic joint infections (early-PJIs) after hip hemiarthroplasty (HHA) for fracture.
Methods: Open-label, multicentre RCT comparing 3gr of fosfomycin-trometamol with non-treatment. A parallel follow-up cohort without ASB was established. Prim...
Aims
The success rates of two-stage revision arthroplasty for infection have evolved since their early description. The implementation of internationally accepted outcome criteria led to the readjustment of such rates. However, patients who do not undergo reimplantation are usually set aside from these calculations. The aim of this study was to inv...
Introduction
Infected post-traumatic distal femur defects remain a therapeutic challenge. Non-biological reconstruction offers an option for avoiding complex biological knee arthrodesis procedures. The CompressⓇ implant is an alternative to the traditional distal femur stemmed megaprosthesis. The aim of this study is to analyse the first patients t...
Background:
Vascularized periosteal graft have demonstrated a tremendous bone healing capacity in children. The objective is to report outcomes on the use of vascularized tibial periosteal graft (VTPG) during bone reconstruction in a series of children with complex bone healing problems.
Patients and methods:
Cases were collected retrospectively...
To describe and compare the characteristics of necrotizing fasciitis (NF) in patients with and without haematological malignancy. All adult patients diagnosed with NF and treated at our hospital were included (January 2010–March 2019). Diagnosis was based on intraoperative findings or consistent clinical/radiological characteristics, and patients w...
Background
External fixator knee arthrodesis is a salvage procedure used primarily in cases of end-stage infected total knee replacement (iTKR). Stable fixation combined with bone-end compression is essential to achieve knee fusion, but providing sufficient stability can be challenging in the presence of severe bone loss. Our hypothesis is that usi...
Background:
Second-stage positive cultures in 2-stage revision arthroplasty are a matter of concern, as their influence in outcomes is not clearly defined. We sought to study reimplantation microbiology when using vancomycin-gentamicin prefabricated cement spacers in hip and knee periprosthetic joint infection. The associations of second-stage pos...
Case:
A 43-year-old former drug user presented with a mycobacterium-caused septic nonunion of the humeral shaft. The patient had undergone 2 previous surgeries for a hematogenous fracture-related infection due to Staphylococcus aureus. The procedures had included debridement, double-plate osteosynthesis, and placement of a gentamicin-loaded bone s...
Background:
Preoperative planning for circular external fixators is considered vital towards achieving the best results for complex post-traumatic tibial deformities, and patient-specific 3D printed (3DP) models were used here as a planning aid. The main goal was to investigate the fidelity of the preoperative planning process, by assessing the po...
Background:
Bone loss is a common problem in periprosthetic joint infection (PJI) scenarios. Modular megaprosthesis (MP) could offer a limb salvage solution in such situations. Concerns about risk of infection relapse, reinfection and implant longevity exist regarding MP use in cases of chronic PJI, rather than standard implants. We therefore soug...
Background:
Candida periprosthetic joint infection (CPJI) is a rare, difficult-to-treat disease. The purpose of this study was to evaluate the clinical characteristics and outcomes of CPJI treated with various surgical and antifungal strategies.
Methods:
We conducted a multicenter retrospective study of all CPJI diagnosed between 2003 and 2015 i...
Fusobacterium nucleatum is an obligately anaerobic gram-negative rod, a component of the microbiome of the oropharynx and the gastrointestinal and urogenital tracts, causing an array of human infections which often include periodontal pathologies. As far as we know, there are no previous publications about acute periprosthetic joint infection due t...
Purpose:
Nonunion is a common complication of lateral condyle humeral (LCH) fractures in children. In situ fixation with a screw and bone grafting is the classically-recommended method of treatment. The purpose of this study is to analyze the feasibility of obtaining a vascularized periosteal flap obtained from the lateral humerus and based on the...
Introduction:
Bone transport techniques have been widely used to solve massive bone defects due to trauma, osteomyelitis or bone tumors. The technique of bone interruption to achieve better new bone formation is a subject of debate. Low-energy osteotomy (LEO) techniques have been proposed as the gold standard. Some authors reject open osteotomy wi...
Objective:
To compare a series of monomicrobial Propionibacterium acnes (P. acnes) knee and hip periprosthetic joint infection (PJI) cases with cases of polymicrobial PJI which included P. acnes. We hypothesized that the presence of a polymicrobial P. acnes infection would lead to worse outcomes than those in cases of monomicrobial P. acnes PJI....
The incidence of prosthetic joint infection (PJI) is expected to increase in the coming years. PJI has serious consequences for patients, and high costs for the health system. The complexity of these infections makes it necessary to organize the vast quantity of information published in the last several years. The indications for the choice of a gi...
The incidence of prosthetic joint infection (PJI) is expected to increase in the coming years. PJI has serious consequences for patients, and high costs for the health system. The complexity of these infections makes it necessary to organize the vast quantity of information published in the last several years. The indications for the choice of a gi...
Bone loss in the distal femur is a common problem in knee revision surgeries. The problem is exacerbated in the context of an active infection. In extreme cases this bone loss could compromise the feasibility of a two-stage exchange protocol using dynamic spacers due to the inherent instability of this type of spacers. Use of a hip prefabricated sp...
Total Joint Arthroplasty (TJA) continues to gain acceptance as the standard of care for the treatment of severe degenerative joint disease, and is considered one of the most successful surgical interventions in the history of medicine. A devastating complication after TJA is infection. Periprosthetic joint infection (PJI), represents one of the maj...
Introduction:
Necrotising fasciitis (NF) is potentially life-threatening soft-tissue infection. Early diagnosis and aggressive surgical debridement are critical to decrease mortality and morbidity. The impacts of new management technologies such as hydro-bisturi-assisted debridement (HAD) and negative pressure wound therapy (NPWT) are not yet clea...
BACKGROUND
Bone loss in the distal femur is a common problem in knee revision surgeries. The problem is exacerbated in the context of an active infection. In extreme cases this bone loss could compromise the feasibility of a two-stage exchange protocol using dynamic spacers due to the inherent instability of this type of spacers. Use of a hip prefa...
It is important to know the spectrum of the microbial aetiology of prosthetic joint infections (PJIs) to guide empiric treatment and establish antimicrobial prophylaxis in joint replacements. There are no available data based on large contemporary patient cohorts. We sought to characterize the causative pathogens of PJIs and to evaluate trends in t...
In patients undergoing hip hemiarthroplasty (HHA) secondary to proximal femur fracture, acute periprosthetic joint infection (PJI) is one of the most important complications. We have detected an increased risk in chronic institutionalized patients (CIP), and higher number of early postoperative infections caused by gram-negative bacteria (GNB), not...
Several types of vascularized periosteal flaps have recently been described for the treatment or prevention of complex non-union in pediatric patients. Among them, a vascularized tibial periosteal graft (VTPG), supplied by the anterior tibial vessels (ATV), has been used successfully as a pedicled flap in a few patients. The purpose of the study is...
Chronic Periprosthetic Joint Infection (C-PJI) is a devastating complication expected to worsen due to the increased joint replacement procedures. Develop reliable diagnostic tools and effective methods of treatment is critical and for this we must understand these infections as a classic model of bacterial biofilm. The two-stage exchange approach...
We revised the first 100 revision total hip arthroplasties using a cementless distal locking revision stem conducted in our referral centre. Average follow-up was 9.2years (range: 5.5-12 years). Harris Hip Score improved from 42.5 to 81.6, and none had thigh pain at last follow-up. No significant stress shielding, osteolysis, or radiologic loosenin...
Periprosthetic joint infection (PJI) is a devastating complication that can occur following any arthroplasty procedure. Approximately half of these infections develop within the first year after arthroplasty, mainly in the first 1 to 3 months. These infections are known as early PJI. It is widely accepted that many early PJIs can be successfully ma...
Bone nonunion in the pediatric population usually occurs in the context of highly unfavorable biological conditions. Recently, the vascularized fibular periosteal flap has been reported as a very effective procedure for treating this condition. Even though a vascularized tibial periosteal graft (VTPG) was described long ago and has been successfull...
It seems simple to define what a PJI is. The problem is that definitions vary depending on the author involved. It has become accepted that the PJI diagnosis is confirmed when there is purulence around the joint, there is a communication between the skin and the implant, and we unequivocally isolate the causative agent(s). In this chapter each of t...
Purpose:
To evaluate the pain level and patient satisfaction as well as the fusion and infection eradication rates after knee arthrodesis using a monolateral external fixator for failed septic total knee replacement (TKR).
Methods:
Records of 10 male and 11 female consecutive patients aged 70 to 88 (mean, 81) years who underwent knee arthrodesis...
Arthroscopic revision of rotator cuff lesions is an increasingly popular procedure with a relatively safe profile. However, associated deep articular infection has been described, with potentially destructive joint sequelae. When occurring, it poses the double challenge of eradicating the infectious agent while preserving the articulation and its f...
Knee arthrodesis is an alternative to amputation for treating recalcitrant septic non-union of the proximal tibia with bone loss, soft-tissue compromise, and knee-joint involvement. Nonetheless, arthrodesis is difficult to achieve if bone loss is massive, and the septic environment can result in failed bone fusion. We report on a 77-year-old man wi...
Foot compartment syndrome is a serious potential complication of foot crush injury, fractures, surgery, and vascular injury. An acute compartment syndrome isolated to the medial compartment of the foot after suffering an ankle sprain is a rare complication.
We report the case of a 31-year-old man who developed a medial foot compartment syndrome aft...
Literature on the reconstruction of the proximal femur in skeletally immature patients with the use of an epiphyseal transplant is scarce and with variable results depending on the indication. We report successful outcomes using a modified vascularized fibular epiphyseal transplant in a 4-year-old boy with an oncologic lesion. We discuss the advant...
The vascularized fibular periosteal flap has been recently described and showed solid angio and osteogenic features. We report the use of a free vascularized fibular periosteal transplant in the treatment of a El-Rosasy-Paley Type III congenital pseudarthrosis of the tibia in a 7-year-old boy, with a prior unsuccessful surgery at the age of three....
This technical note describes an intraoperatively custom-made, antibiotic-loaded bone cement roof, used in conjunction with a prefabricated hip spacer to improve component stability, as part of the first stage of a two-stage procedure for an infected hip implant. This technique was successfully used in seven cases who presented with extensive super...
This chapter focuses on external fixation as a tool to achieve knee arthrodesis, in managing failure of total knee arthroplasty due to infection.
Preoperative identification of the infecting micro-organism is of paramount importance in the treatment protocol for chronic periprosthetic joint infections, as it enables selection of the most appropriate antibiotic treatment. Preoperative joint aspiration, the most commonly used sampling technique, has proven to have a broad range of sensitivity...
The application of oncologic criteria in the sequential surgical treatment of chronic osteomyelitis foci and septic pseudarthrosis, through segmental resections, produces extensive bone defects. Once the septic process is under control, in a stable and well vascularized atmosphere, we perform reconstruction of intercalary defects through bone trans...
Periprosthetic hip fracture is a severe complication of total hip arthroplasty (THA). Surgical treatment of such fractures is a challenge, as it is often accompanied by fracture comminution, bone deficiency, and femoral component loosening
