ICM symposium at AAOS info and ICM book availability updates

Dear Delegates, For those of you who may be attending the AAOS next week, we wanted to let you know that copies of the ICM book will be distributed during the ICM symposium to be held on Thursday 6-7:30 PM at Titan Room Venetian(sponsored by Convatec) and also another symposium on the same day from 9-10:30 PM at Tao, Venetian(Sponsored by Heraeus). In addition, our industry partners Aerobiotix, Acelity, and MicrogenDx, have agreed to have copies of the book for distribution in their booth.

See you in Vegas

Have you checked out the new version of the PJIDx on the App?


Paper of the week: Labeled white blood cell/bone marrow single-photon emission computed tomography with computed tomography fails in diagnosing chronic periprosthetic shoulder joint infection.

Paper of the week: Labeled white blood cell/bone marrow single-photon emission computed tomography with computed tomography fails in diagnosing chronic periprosthetic shoulder joint infection. Falstie-Jensen T, Daugaard H, Søballe K, Ovesen J, Arveschoug AK, Lange J; ROSA study group. J Shoulder Elbow Surg. 2019 Jan 31. pii: S1058-2746(18)30782-1. doi: 10.1016/j.jse.2018.10.024.

Summary by Dr. Sreeram Penna

This prospective cohort study assessed the diagnostic accuracy of combined labeled leukocyte (WBC) and technetium 99m sulfur colloid bone marrow imaging (WBC/BM) single-photon emission computed tomography-computed tomography in chronic shoulder prosthetic joint infection (PJI). Researchers reviewed patients with a failed shoulder arthroplasty, which was defined as any unsatisfactory result of any cause. Researchers considered shoulder infected if 3 positive tissue cultures with the same bacteria or if a sinus tract communicating to the prosthesis was present. The final cohort of 29 patients was included in the study. Of these 11 were considered positive based on infection definition criteria used. Only 2 patients in the infected group had positive WBC/BM single-photon emission computed tomography (2/11, 18.2%). There were no false positive cases in the study. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of detecting chronic shoulder PJI using this test was 0.18, 1.00, 1.00, 0.67, and 0.69 respectively. Although the study had a low sample size it has shown a lack of utility of bone scan in improving the diagnostic accuracy of chronic shoulder PJI.


ICM document update: Russian translation completed

ICM document Russian translation is completed. It is available online at the following link.


Paper of the week: The Timing of Corticosteroid Injections After Arthroscopic Shoulder Procedures Affects Postoperative Infection Risk

Paper of the week: The Timing of Corticosteroid Injections After Arthroscopic Shoulder Procedures Affects Postoperative Infection Risk. Kew ME, Cancienne JM, Christensen JE, Werner BC. Am J Sports Med. 2019 Feb 13:363546518825348. doi: 10.1177/0363546518825348.

Commentary by Thema A. Nicholson MS, Surena Namdari MD

Arthroscopic shoulder surgery is exceedingly common and results in reliable pain relief and functional restoration. Unfortunately, there is a subset of patients that have pain or stiffness following shoulder arthroscopy that affects the quality of life and ability to participate in rehabilitation. A corticosteroid injection may be considered in these patients; however, the benefits of improved pain must be balanced by the risks of infection and/or poor tissue healing. This study sought to establish whether or not corticosteroid injections after arthroscopic surgery are a safe option to provide pain relief without predisposing patients to infection. A query of private payer and Medicare databases yielded 3946 patients that underwent an injection within 4 months after arthroscopic shoulder surgery. Patients who underwent an injection within 1 month after arthroscopic shoulder surgery had a 3.5% infection rate compared to a ≤0.5% infection rate in patients who underwent an injection at 2, 3 or 4 months. While data from large national databases can be flawed in many ways, this study supports our current practice of avoiding corticosteroid injections in the early postoperative period after shoulder arthroscopy. The influence of injections on tissue healing remains unknown.


Paper of the week: Orthopedic Implant-Associated Infection by Multidrug-Resistant Enterobacteriaceae.

Paper of the week: Orthopedic Implant-Associated Infection by Multidrug Resistant Enterobacteriaceae. Pfang BG, García-Cañete J, García-Lasheras J, Blanco A, Auñón Á, Parron-Cambero R, Macías-Valcayo A, Esteban J. J Clin Med. 2019 Feb 8;8(2). pii: E220. doi: 10.3390/jcm8020220.

Summary and Editorial by Sreeram Penna

This is a retrospective observational study from a single institution. Researchers reviewed all cases of orthopaedic implant-associated multidrug-resistant Enterobacteriaceae (MDREB). The overall incidence of MDREB was 6.4% (31/482). Six patients were excluded, and twenty-five patients are included in the study. Patients included ten prosthetic joints, seven osteosyntheses, six combination of prosthetic joint and osteosynthesis, and two spacers. MDREB is defined as any enterobacteria resistant to three or more antibacterial classes. Bacteria in this cohort was 12 extended spectrum beta-lactamase producing Escherichia coli, 3 OXA-48-carbapenamase producing Klebsiella pneumoniae, nine extended-spectrum beta-lactamase producing Proteus mirabilis and ten cases were polymicrobial infections. Overall 16 patients (64%) underwent implant removal. This included 7 cases of resection arthroplasty and 3 cases of Amputation. All patients with implant removal achieved 100% infection clearance. Only 33% of patients with retained implants had infection clearance. Four patients died within one year of diagnosis.

Literature review shows an increase in multidrug-resistant Gram-negative bacterial joint infections.[1] These multidrug-resistant Gram-negative bacterial infections are often difficult to control and require special antibiotics combinations to treat and also to prevent further development of antibiotic resistance.[2] Surgical procedures require implant removal for infection clearance.[3] This study provides further insights into MDREB orthopaedic implant infections and clearly shows how dangerous these are.


[1] Murillo O, Grau I, Lora-Tamayo J, Gomez-Junyent J, Ribera A, Tubau F, et al. The changing epidemiology of bacteraemic osteoarticular infections in the early 21st century. Clin Microbiol Infect 2015;21:254.e1-8. doi:10.1016/j.cmi.2014.09.007.
[2] Hawkey PM, Warren RE, Livermore DM, McNulty CAM, Enoch DA, Otter JA, et al. Treatment of infections caused by multidrug-resistant Gram-negative bacteria: report of the British Society for Antimicrobial Chemotherapy/Healthcare Infection Society/British Infection Association Joint Working Party. J Antimicrob Chemother 2018;73:iii2–78. doi:10.1093/jac/dky027.
[3] Papadopoulos A, Ribera A, Mavrogenis AF, Rodriguez-Pardo D, Bonnet E, Salles MJ, et al. Multidrug-resistant and extensively drug-resistant Gram-negative prosthetic joint infections: Role of surgery and impact of colistin administration. Int J Antimicrob Agents 2018. doi:10.1016/j.ijantimicag.2018.10.018.