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Article ; Online: The "Magic Number" for Microbiological Testing for Fracture-Related Infection: Commentary on an article by M. Dudareva, BMBCh, MRCP, et al.: "Providing an Evidence Base for Tissue Sampling and Culture Interpretation in Suspected Fracture-Related Infection".

Moojen, Dirk Jan F

The Journal of bone and joint surgery. American volume

2021 Volume 103, Issue 11, Page(s) e46

MeSH term(s)	Cholangiopancreatography, Magnetic Resonance ; Fractures, Bone ; Humans
Language	English
Publishing date	2021-06-05
Publishing country	United States
Document type	Journal Article ; Comment
ZDB-ID	220625-0
ISSN	1535-1386 ; 0021-9355
ISSN (online)	1535-1386
ISSN	0021-9355
DOI	10.2106/JBJS.21.00251
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Article: Improved patient reported outcomes with functional articulating spacers in two-stage revision of the infected hip.

Veltman, Ewout S / Moojen, Dirk Jan F / Poolman, Rudolf W

World journal of orthopedics

2020 Volume 11, Issue 12, Page(s) 595–605

Abstract: Background: Two-stage revision arthroplasty with an antibiotic-loaded spacer is the treatment of choice in chronically infected total hip arthroplasties. Interval spacers can be functional articulating or prefabricated. Functional results of these ... ...

Abstract	Background: Two-stage revision arthroplasty with an antibiotic-loaded spacer is the treatment of choice in chronically infected total hip arthroplasties. Interval spacers can be functional articulating or prefabricated. Functional results of these spacers have scarcely been reported. Aim: To compare retrospectively the patient reported outcome and infection eradication rate after two-stage revision arthroplasty of the hip with the use of a functional articulating or prefabricated spacer. Methods: All patients with two-stage revision of a hip prosthesis at our hospital between 2003 and 2016 were included in this retrospective cohort study. Patients were divided into two groups; patients treated with a functional articulating spacer or with a prefabricated spacer. Patients completed the Hip Osteoarthritis Outcome Score and the EQ-5D-3L (EQ-5D) and the EQ-5D quality of life thermometer (EQ-VAS) scores. Primary outcomes were patient reported outcome and infection eradication after two-stage revision. The results of both groups were compared to the patient acceptable symptom state for primary arthroplasty of the hip. Secondary outcomes were complications during spacer treatment and at final follow-up. Descriptive statistics, mean and range are used to represent the demographics of the patients. For numerical variables, students' Results: We consecutively treated 55 patients with a prefabricated spacer and 15 patients with a functional articulating spacer of the hip. The infection eradication rates for functional articulating and prefabricated spacers were 93% and 78%, respectively ( Conclusion: Functional articulating spacers lead to improved patient reported functional outcome and less perioperative complications after two-stage revision arthroplasty of an infected total hip prosthesis, while maintaining a similar infection eradication rate compared to prefabricated spacers.
Language	English
Publishing date	2020-12-18
Publishing country	United States
Document type	Journal Article
ZDB-ID	2649712-8
ISSN	2218-5836
ISSN	2218-5836
DOI	10.5312/wjo.v11.i12.595
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Article ; Online: Similar success rates for single and multiple debridement surgery for acute hip arthroplasty infection--reply.

Moojen, Dirk Jan F

Acta orthopaedica

2015 Volume 86, Issue 1, Page(s) 142

MeSH term(s)	Anti-Bacterial Agents/therapeutic use ; Arthroplasty, Replacement, Hip/adverse effects ; Debridement/methods ; Female ; Humans ; Male ; Prosthesis-Related Infections/drug therapy ; Prosthesis-Related Infections/surgery
Chemical Substances	Anti-Bacterial Agents
Language	English
Publishing date	2015-02
Publishing country	England
Document type	Comment ; Letter
ZDB-ID	2180677-9
ISSN	1745-3682 ; 1745-3674
ISSN (online)	1745-3682
ISSN	1745-3674
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Article ; Online: Exploring new strategies for infection treatment: commentary on an article by Cengiz Yilmaz, MD, et al.: "Bacteriophage therapy in implant-related infections. an experimental study".

Moojen, Dirk Jan F

The Journal of bone and joint surgery. American volume

2013 Volume 95, Issue 2, Page(s) e11 1–2

MeSH term(s)	Animals ; Bacteriophages ; Male ; Prosthesis-Related Infections/therapy
Language	English
Publishing date	2013-01-16
Publishing country	United States
Document type	Comment ; Journal Article
ZDB-ID	220625-0
ISSN	1535-1386 ; 0021-9355
ISSN (online)	1535-1386
ISSN	0021-9355
DOI	10.2106/JBJS.L.01419
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Article: Prosthetic Joint Infection and Wound Leakage After the Introduction of Intraoperative Wound Irrigation With a Chlorhexidine-Cetrimide Solution: A Large-Scale Before-After Study.

Willigenburg, Nienke W / Yesilkaya, Fatih / Rutgers, Marijn / Moojen, Dirk Jan F / Poolman, Rudolf W / Kempen, Diederik H R

Arthroplasty today

2022 Volume 19, Page(s) 101053

Abstract: Background: Intraoperative chlorhexidine irrigation could be a valuable additive to systemic antibiotics to prevent infections after total joint arthroplasties. However, it may cause cytotoxicity and impair wound healing. This study evaluates the ... ...

Abstract	Background: Intraoperative chlorhexidine irrigation could be a valuable additive to systemic antibiotics to prevent infections after total joint arthroplasties. However, it may cause cytotoxicity and impair wound healing. This study evaluates the incidence of infection and wound leakage before and after the introduction of intraoperative chlorhexidine lavage. Methods: All 4453 patients receiving a primary hip or knee prosthesis between 2007 and 2013 in our hospital were retrospectively included. They all underwent intraoperative lavage before wound closure. Initially, wound irrigation with 0.9% NaCl was standard care (n = 2271). In 2008, additional irrigation with a chlorhexidine-cetrimide (CC) solution was gradually introduced (n = 2182). Data on the incidence of prosthetic joint infections and wound leakage, as well as relevant baseline and surgical characteristics, were derived from medical charts. Chi-square analysis was used to compare the incidence of infection and wound leakage between patients with and without CC irrigation. Multivariable logistic regression was used to assess robustness of these effects by adjusting for potential confounders. Results: The prosthetic infection rate was 2.2% in the group without CC irrigation vs 1.3% in the group with CC irrigation ( Conclusions: Intraoperative wound irrigation using a CC solution does not seem to affect the risk of prosthetic joint infection or wound leakage. Observational data easily yield misleading results, so prospective randomized studies are needed to verify causal inference. Level of evidence: Level III-uncontrolled before and after the study.
Language	English
Publishing date	2022-11-28
Publishing country	United States
Document type	Journal Article
ISSN	2352-3441
ISSN	2352-3441
DOI	10.1016/j.artd.2022.10.003
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Article: Long-term Conventionally Dosed Vancomycin Therapy In Patients With Orthopaedic Implant-related Infections Seems As Effective And Safe As Long-term Penicillin Or Clindamycin Therapy. A Retrospective Cohort Study Of 103 Patients.

Aleman, Jacomien / Moojen, Dirk Jan F / van Ogtrop, Marc L / Poolman, Rudolf W / Franssen, Eric J F

Journal of bone and joint infection

2018 Volume 3, Issue 2, Page(s) 82–86

Abstract: ... ...

Abstract	Objectives
Language	English
Publishing date	2018-04-27
Publishing country	Germany
Document type	Journal Article
ISSN	2206-3552
ISSN	2206-3552
DOI	10.7150/jbji.20279
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Article: Two-stage revision arthroplasty for coagulase-negative staphylococcal periprosthetic joint infection of the hip and knee.

Veltman, Ewout S / Moojen, Dirk Jan F / van Ogtrop, Marc L / Poolman, Rudolf W

World journal of orthopedics

2019 Volume 10, Issue 10, Page(s) 348–355

Abstract: Background: Periprosthetic joint infections (PJIs) are frequently caused by coagulase-negative Staphylococci (CoNS), which is known to be a hard-to-treat microorganism. Antibiotic resistance among causative pathogens of PJI is increasing. Two-stage ... ...

Abstract	Background: Periprosthetic joint infections (PJIs) are frequently caused by coagulase-negative Staphylococci (CoNS), which is known to be a hard-to-treat microorganism. Antibiotic resistance among causative pathogens of PJI is increasing. Two-stage revision is the favoured treatment for chronic CoNS infection of a hip or knee prosthesis. We hypothesised that the infection eradication rate of our treatment protocol for two-stage revision surgery for CoNS PJI of the hip and knee would be comparable to eradication rates described in the literature. Aim: To evaluate the infection eradication rate of two-stage revision arthroplasty for PJI caused by CoNS. Methods: All patients treated with two-stage revision of a hip or knee prosthesis were retrospectively included. Patients with CoNS infection were included in the study, including polymicrobial cases. Primary outcome was infection eradication at final follow-up. Results: Forty-four patients were included in the study. Twenty-nine patients were treated for PJI of the hip and fifteen for PJI of the knee. At final follow-up after a mean of 37 mo, recurrent or persistent infection was present in eleven patients. Conclusion: PJI with CoNS can be a difficult to treat infection due to increasing antibiotic resistance. Infection eradication rate of 70%-80% may be achieved.
Language	English
Publishing date	2019-10-18
Publishing country	United States
Document type	Journal Article
ZDB-ID	2649712-8
ISSN	2218-5836
ISSN	2218-5836
DOI	10.5312/wjo.v10.i10.348
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Article ; Online: Comparison of early migration patterns between a ceramic and polyethylene liner in uncemented Trabecular Titanium cups: a 2-year randomized controlled trial of 52 hips using radiostereometric analysis.

Klaassen, Amanda D / Schäffer, Elisabeth A / Willigenburg, Nienke W / Van Beers, Loes W A H / Scholtes, Vanessa A B / Van der Hulst, Victor P M / Koster, Lennard A / Kaptein, Bart L / Moojen, Dirk Jan F / Poolman, Rudolf W

Acta orthopaedica

2022 Volume 93, Page(s) 451–458

Abstract: Background and purpose: Ceramic liners may reduce early stability of uncemented acetabular components due to higher stiffness. However, the bone ingrowth capacities of porous trabecular titanium might compensate for this effect. This prospective ... ...

Abstract	Background and purpose: Ceramic liners may reduce early stability of uncemented acetabular components due to higher stiffness. However, the bone ingrowth capacities of porous trabecular titanium might compensate for this effect. This prospective randomized trial quantifies migration patterns of the Delta-TT cup, and compares polyethylene and ceramic liners. Patients and methods: Patients undergoing primary uncemented total hip arthroplasty with the Delta-TT cup and femoral stem with ceramic head were randomized to a polyethylene (n = 25) or ceramic (n = 28) liner. Radiostereometric analysis (RSA) radiographs, patient-reported hip function (HOOS-PS, OHS), and quality of life (EQ5D) were collected at baseline and 1.5, 3, 6, 12, and 24 months postoperatively. Model-based RSA was used to calculate 3D cup translation and rotation, and mixed models were used to compare effects over time between groups. Results: At 2 years follow-up, Delta-TT cups showed similar mean proximal translation of 0.56 mm (95% CI 0.38-0.75) in the ceramic (CE) group and 0.54 mm (0.30-0.77) in the polyethylene (PE) group, with a between group effect of 0.02 mm (-0.20-0.23). Most cup migration occurred in the first 1.5 to 3 months, stabilizing within 6 months. Any between-group effects were ≤ 0.30 mm for translation and ≤ 0.45° for rotation. Improvements in patient-reported hip function and quality of life were similar in both groups. Interpretation: Regardless of liner type, Delta-TT cups showed some initial migration and stabilized within 6 months, which seems promising for long-term fixation in both cup-liner constructs.
MeSH term(s)	Arthroplasty, Replacement, Hip/adverse effects ; Ceramics ; Hip Prosthesis ; Humans ; Polyethylene ; Prospective Studies ; Prosthesis Design ; Prosthesis Failure ; Quality of Life ; Radiostereometric Analysis ; Titanium
Chemical Substances	Polyethylene (9002-88-4) ; Titanium (D1JT611TNE)
Language	English
Publishing date	2022-04-28
Publishing country	Sweden
Document type	Journal Article ; Randomized Controlled Trial
ZDB-ID	2180677-9
ISSN	1745-3682 ; 1745-3674
ISSN (online)	1745-3682
ISSN	1745-3674
DOI	10.2340/17453674.2022.2267
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Article ; Online: Similar risk of complete revision for infection with single-dose versus multiple-dose antibiotic prophylaxis in primary arthroplasty of the hip and knee: results of an observational cohort study in the Dutch Arthroplasty Register in 242,179 patients.

Veltman, Ewout S / Lenguerrand, Erik / Moojen, Dirk Jan F / Whitehouse, Michael R / Nelissen, Rob G H H / Blom, Ashley W / Poolman, Rudolf W

Acta orthopaedica

2020 Volume 91, Issue 6, Page(s) 794–800

Abstract: Background and purpose - The optimal type and duration of antibiotic prophylaxis for primary arthroplasty of the hip and knee are subject to debate. We compared the risk of complete revision (obtained by a 1- or 2-stage procedure) for periprosthetic ... ...

Abstract	Background and purpose - The optimal type and duration of antibiotic prophylaxis for primary arthroplasty of the hip and knee are subject to debate. We compared the risk of complete revision (obtained by a 1- or 2-stage procedure) for periprosthetic joint infection (PJI) after primary total hip or knee arthroplasty between patients receiving a single dose of prophylactic antibiotics and patients receiving multiple doses of antibiotics for prevention of PJI. Patients and methods - A cohort of 130,712 primary total hip and 111,467 knee arthroplasties performed between 2011 and 2015 in the Netherlands was analyzed. We linked data from the Dutch arthroplasty register to a survey collected across all Dutch institutions on hospital-level antibiotic prophylaxis policy. We used restricted cubic spline Poisson models adjusted for hospital clustering to compare the risk of revision for infection according to type and duration of antibiotic prophylaxis received. Results - For total hip arthroplasties, the rates of revision for infection were 31/10,000 person-years (95% CI 28-35), 39 (25-59), and 23 (15-34) in the groups that received multiple doses of cefazolin, multiple doses of cefuroxime, and a single dose of cefazolin, respectively. The rates for knee arthroplasties were 27/10,000 person-years (95% CI 24-31), 40 (24-62), and 24 (16-36). Similar risk of complete revision for infection among antibiotic prophylaxis regimens was found when adjusting for confounders. Interpretation - In a large observational cohort we found no apparent association between the type or duration of antibiotic prophylaxis and the risk of complete revision for infection. This does question whether there is any advantage to the use of prolonged antibiotic prophylaxis beyond a single dose.
MeSH term(s)	Anti-Bacterial Agents/administration & dosage ; Antibiotic Prophylaxis/methods ; Arthroplasty, Replacement, Hip/adverse effects ; Arthroplasty, Replacement, Hip/methods ; Arthroplasty, Replacement, Knee/adverse effects ; Arthroplasty, Replacement, Knee/methods ; Cefazolin/administration & dosage ; Cefuroxime/administration & dosage ; Dose-Response Relationship, Drug ; Duration of Therapy ; Female ; Humans ; Male ; Middle Aged ; Netherlands/epidemiology ; Outcome and Process Assessment, Health Care ; Prosthesis-Related Infections/diagnosis ; Prosthesis-Related Infections/epidemiology ; Prosthesis-Related Infections/prevention & control ; Prosthesis-Related Infections/surgery ; Reoperation/methods ; Reoperation/statistics & numerical data ; Risk Adjustment/methods ; Risk Adjustment/statistics & numerical data
Chemical Substances	Anti-Bacterial Agents ; Cefazolin (IHS69L0Y4T) ; Cefuroxime (O1R9FJ93ED)
Language	English
Publishing date	2020-07-23
Publishing country	Sweden
Document type	Journal Article ; Observational Study ; Research Support, Non-U.S. Gov't
ZDB-ID	2180677-9
ISSN	1745-3682 ; 1745-3674
ISSN (online)	1745-3682
ISSN	1745-3674
DOI	10.1080/17453674.2020.1794096
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Article: Antibiotic Prophylaxis and DAIR Treatment in Primary Total Hip and Knee Arthroplasty, A National Survey in The Netherlands.

Veltman, Ewout S / Moojen, Dirk Jan F / Nelissen, Rob Ghh / Poolman, Rudolf W

Journal of bone and joint infection

2018 Volume 3, Issue 1, Page(s) 5–9

Abstract: Background: To prevent postoperative infection the use of systemic antibiotic prophylaxis is common ground. Type of antibiotic used and duration of prophylaxis are subject to debate. In case of suspected early periprosthetic infection a debridement, ... ...

Abstract	Background: To prevent postoperative infection the use of systemic antibiotic prophylaxis is common ground. Type of antibiotic used and duration of prophylaxis are subject to debate. In case of suspected early periprosthetic infection a debridement, antibiotics and implant retention (DAIR) procedure is treatment of first choice. This study evaluated the antibiotic prophylaxis and DAIR treatment protocols nationwide as well as reporting of these DAIR procedures to the national joint registry. Methods: All institutions that performed total hip or knee arthroplasty were contacted to complete a 16-question online survey. Questions included availability of a protocol, type and duration of antibiotic prophylaxis used and tendency to register infectious complications in the Dutch Arthroplasty Register. Results: All ninety-nine consulted institutions responded to this survey. All but one institutions have a standardized hospital based protocol for antibiotic prophylaxis in primary total hip or knee arthroplasty. Cefazolin was antibiotic prophylaxis of choice in ninety-four institutions for both primary hip and knee arthroplasty. In ten institutions one preoperative gift of antibiotic prophylaxis was administered. A protocol describing treatment when suspecting early periprosthetic joint infection was present in seventy-one institutions. When performing a DAIR procedure modular parts were exchanged in seventy institutions in case of a hip prosthesis and in eighty-one institutions in case of a knee prosthesis. Sixty-three institutions register DAIR procedures in the Dutch Arthroplasty Register. Interpretation: In contradiction to the results of a recent study in Great Britain, we have found only little variety in availability of protocols and in the type of antibiotic used as prophylaxis in primary total hip and knee arthroplasty in The Netherlands. Not every institution has a protocol for treatment in suspicion of early infection. Although mobile parts are exchanged in the majority of cases, there appears to be an underreporting of DAIR procedures in the Dutch Arthroplasty Register.
Language	English
Publishing date	2018-01-01
Publishing country	Germany
Document type	Journal Article
ISSN	2206-3552
ISSN	2206-3552
DOI	10.7150/jbji.20259
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