Management of Periprosthetic Joint Infection

Klaus-Dieter Kühn (Ed.)

Management of Periprosthetic Joint InfectionA global perspective on diagnosis, treatment options, prevention strategies and their economic impact

With 196 figures

123

EditorKlaus-Dieter KühnDepartment of Orthopaedic SurgeryMedical University GrazAustria

Library of Congress Control Number: 2017946542

ISBN 978-3-662-54468-6 978-3-662-54469-3 (eBook)https://doi.org/10.1007/978-3-662-54469-3

Springer© Springer-Verlag GmbH Germany 2018This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, repro-duction on microfilms or in any other physical way, and transmission or information storage and retrieval, electro-nic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed.The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use.The publisher, the authors and the editors are safe to assume that the advice and information in this book are belie-ved to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made.

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V

Medical University of Graz

The Roman encyclopaedist Aulus Cornelius Celsus (ca. 25 BC–ca. 50 AD) described the di-agnosis and therapy of fistulae caused by infectious disease, followed by the Andalusian phy-sician and surgeon Abulcasis (Abu al-Qasim al-Zahrawi; 936 AD–1013 AD), who had already developed sophisticated surgical instruments to probe and excise these fistulae (see . Fig. 1). At a time when electronically downloadable open-access articles are en vogue, the present volume stands in the tradition of good old-fashioned books with the great advantage of giving the readers a concise overview of the different topics. Professor Kühn has successfully man-aged to motivate a large number of internationally renowned experts in the diagnosis and treatment of periprosthetic joint infection to put their compressed experience, ideas, and recommendations into this volume. I sincerely thank him for this effort and hope you, the reader, gain new ideas from this book that will contribute towards the successful treatment of your patients.

A. Leithner

VI Medical University of Graz

. Fig. 1 Surgical instruments; anon, after designs originally drawn by Abulcasis (ca. 1000); Woodcut circa 1500; Chauliac, Guy de, Chirurgia parva. (Wellcome Library, London; https://wellcomeimages.org/indexplus/image/L0002051.html)

VII

Foreword

The editor of this book, Klaus-Dieter Kühn, has succeeded in motivating many well-known experts to present their knowledge in the field of periprosthetic joint infections (PJI). Amongst these authors you will find different specialists – orthopaedic surgeons, infectious disease specialists and microbiologists. The chapters focus on a range of issues related to PJI, including economic factors, clinical aspects, diagnosis, prevention, microbiologic analyses, treatment algorithms, antibiotic-loaded bone cement, spacers and the potential of implants with anti-in-fective coating.

The strength of this book lies in the generously illustrated chapters that present a great varie-ty of PJI cases. In presenting these cases, the authors explain the basis of their decisions for an adequate treatment. The careful study of this illustrative material allows the reader to choose the most appropriate algorithm for their practice. However, there is not much discussion on the results achieved with these algorithms.

This volume can be recommended to anyone dealing with PJI as a treasure trove of ideas. It is of special interest for orthopaedic surgeons or infectious disease specialists who are con-fronted with clinical infections. It will be the duty of each individual reader to gather their own clinical experience on the basis of the new ideas presented in this book.

The treatment of musculoskeletal infections has changed a great deal in the past few decades. One of the most important achievements is that treatment of musculoskeletal infections is decided in a team. This should be composed of at least an orthopaedic surgeon and an infec-tious disease specialist, supported on a case-by-case basis by a microbiologist, a pathologist and a plastic surgeon. In countries that do not have the speciality of infectious diseases, intern-ists should be motivated to acquire special knowledge in this field.

As a young resident in the 1970s, I was shocked by the fate of patients affected by PJI. I often saw them suffering from large open wounds after incomplete removal of the implants and the bone cement. Frequently, they remained handicapped for the rest of their life. Fortunately, step by step, we learnt how to improve this situation. After realizing that debridement means the complete removal of all foreign bodies – including any gentamicin beads left behind – healing of the wounds could be achieved. New ideas such as loading bone cement with gentamicin, re-implantation of a prosthesis after a successful Girdlestone situation and the method of Buchholz, daring to carry out a one-step exchange in PJI, came into the picture.

At the orthopaedic department in Liestal Hospital near Basel we were faced with a growing number of patients who were referred to us with bone infections. Progressively, we learnt about the key elements necessary for a better handling of these cases. A thorough debridement in-cluded not only the removal of all foreign bodies, but also an adequate resection of necrotic bone. We tested the quality of debridement by analysing the resected bone in our own labora-tory for non-decalcified histology so as to be sure not to resect neither too much nor too little. After debridement we proceeded to immediate closure of all wounds, if necessary with the help of the plastic surgeon instead of allowing for a delay by application of negative pressure dressing. Any imminent leaking of a postoperative wound was prevented by an immediate re-intervention completed with new drainage.

VIII Foreword

Re-implantation of a total joint after a Girdlestone hip was successfully changed to a two-step replacement with an interval of only 2–3 weeks. Following the idea of Buchholz, in cases of PJI proven by arthrocentesis presenting with uneventful tissues we favoured a one-step ex-change. Finally, revision with retention of the prosthesis was chosen for early infections of up to 3 weeks. By introducing this Liestal algorithm the number of recurrences gradually de-creased, as proved in the repeated scientific follow-ups of all our cases.

Using the following additional diagnostic measures, the number of PJI without known micro-organisms dropped below 4%: discontinuation of the antibiotic therapy for 2 weeks, harvesting of three to five tissue samples instead of swabs, sonication of the removed foreign bodies and leucocyte count in the synovial fluid.

Feeling that I was not sufficiently trained to manage the antibiotic therapy, I looked for help, which I found with the infectious disease specialist Werner Zimmerli, who worked at the University of Basel. He later changed to Liestal where he became the head of the internal medicine department. To treat early biofilms without exchange of the prosthesis represented a significant challenge. We could achieve much better results treating early staphylococcal infections by adding rifampicin to the conventional antibiotic. This was proven with a rand-omized study.

A number of micro-organisms were resistant to our two-step exchange with a short interval. Infections by so-called difficult-to-treat bacteria – such as small colony variants of common bacteria, enterococci, rifampicin-resistant staphylococci, fungi and some others – could be treated by another type of two-stage procedure that included a long interval of 8–10 weeks without a spacer. During this period, a curative antibiotic treatment of the infection without foreign material can be achieved.

The main secrets for a successful treatment of PJI are:

4 Clear definition of the different elements of the treatment and their application without compromise. 4 Rigorous application of an algorithm once it has been selected as a basis for a scientific

control 4 Collaboration of the orthopaedic surgeon and the infectious disease specialist with

access to specialized partners in microbiology, histology and plastic surgery 4 Long-term follow-up of all the patients treated, including a scientific analysis of the

results in order to prove the quality of the chosen algorithm

To promote better treatment, »Swiss orthopaedics« in 2006 created an expert group on »infec-tions of the musculoskeletal system« comprising a representative number of orthopaedic surgeons and infectious disease specialists. This group edited a pocketbook including an e-book version on the treatment of these infections, which can be ordered for free on www.swissorthopaedics.ch or www.ebjis.org.

If this present book on PJI motivates the reader to do a better job in the therapy of these un-fortunate patients by following strict algorithms and practising an interdisciplinary treatment, then it has achieved an important goal.

Peter E. OchsnerEmeritus Extraordinarius Professor in Orthopaedics at the University of Basel

IX

Preface

Periprosthetic joint infection (PJI) is among the most serious complications in the field of endoprosthetics. The number of PJIs is increasing worldwide and poses a real interdisciplinary challenge for everyone involved. Beside its immense impact on patients and the health-care system, the diagnosis and management of PJI are very difficult, since there is no »gold standard«.

This book provides basic and advanced knowledge of the diverse aspects of periprosthetic joint infections and a comprehensive overview on a global scale, which was possible only because of the close collaboration of international experts. Various issues such as diagnosis, treatment options, prevention strategies and their economic impact are addressed in order to exchange versatile experience and know-how. Furthermore, attention was given to antibiotic-loaded bone cements (ALBC), spacer management and anti-infective implant coatings.

This compilation offers an ample summary to a multidisciplinary audience. Not only for the microbiologist, who is responsible for identifying the causative germs, the infectious disease specialist, who can recommend the appropriate antibiotic therapy, the clinical pharmacist, who is consulted regularly throughout the therapy to discuss the risk of potential drug inter-actions, or the surgeon, who will proceed with the revision surgery, following defined algo-rithms, but also for any other interested reader. Moreover, it may also help affected patients to understand the clinical procedure.

This book aims to contribute to a fruitful international debate concerning the ideal manage-ment of PJI. In addition, the reader can use this book as a solid platform for comparing their own approach to PJI treatment with the specialists’ recommendations.

Prof. Dr. Klaus-Dieter KühnDepartment of Orthopa edic SurgeryMedical University of GrazAustria

Acknowledgements

My sincere thanks to all the authors for agreeing to provide a scientific contribution to this book. Despite having many other obligations, they took the time to share their clinical experi-ence and offer valuable information for the reader. Based on this essential support, it was possible to give a comprehensive overview of the topic of periprosthetic joint infections on a global scale.

Because of the abundant clinical data, it would have been impossible to produce a successful compilation of all the multifaceted contributions without additional scientific support. Thus, I would like to express a special thanks to S. Vogt and C. Berberich for our great scientific discus-sions, as well as E. Lieb, L. Schell, M. Schulze, J. Schmiedel, O. Vornkahl, D. Müller, and A. Klotz for their support during the review procedure. In particular, I thank A. Roggeman, who was always willing to offer assistance in the international correspondence and networking.

Since the book includes various contributions from many different countries it was often necessary to contact the authors directly. This would have been impossible without S. Bui-tendag and A. Peyper (SA), M. Zaaijer (B, NL), T. Smith (UK), S. Tye and C. Berberich (AUS), L. Kiontke (UK, AUS, USA), E. Lieb (F), and T. Kluge (USA), whom I want to thank for their commitment.

Furthermore, I would like to thank M. Zimni for the creation of the book cover and other graphics, U. Dächert of Springer for managing the publication of the book, I. Athanassiou for professional editing, and S. Janka for the initial compilation of the submitted contributions.

Special thanks to A. Holl for her competent assistance in creating figures as well as in viewing and editing the contributions all the way to the printing stage.

My thanks to Prof. Dr. A. Leithner, Medical University of Graz, Department of Orthopaedic Surgery, for the opportunity and freedom to create the present book.

Last, but not least, I would like to thank Prof. P. Ochsner for the friendly and professional foreword.

XI

Table of Contents

1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

1.1 Interview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

2 Economic Aspects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

2.1 Economic Aspects of Peri prosthetic Joint Infections . . . . . . . . . . . . . . . . . . . . . 62.2 Periprosthetic Joint Infections in the Spectrum of the German Diagnosis-Related

Groups System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

3 Clinical Aspects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

3.1 Clinical Aspects of Prosthetic Joint Infection . . . . . . . . . . . . . . . . . . . . . . . . . . 26

4 Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43

4.1 Diagnosis of Prosthetic Joint Infections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 454.2 Diagnosis of Pathogens . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 594.3 Diagnosis of Pathogens Causing Periprosthetic Joint Infections . . . . . . . . . . . . . . 71

5 Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77

5.1 Prophylaxis for Implant- Related Infections: Current State of the Art . . . . . . . . . . . 795.2 Prophylaxis During Total Hip and Knee Replacement . . . . . . . . . . . . . . . . . . . . . 865.3 Strategies for Preventing Infections in Total Hip and Total Knee Arthroplasty . . . . . 1015.4 Treatment of Bone and Joint Infection: Clinical Practice at the Centre de Référence

des Infections Ostéo-Articulaires Complexes (CRIOAc) Lyon, France . . . . . . . . . . . 110

6 Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127

6.1 Treatment of PJI: Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1306.2 Treatment of Orthopaedic Septic Revisions at the Medical University of Graz . . . . . 1436.3 Treatment of Prosthetic Joint Infections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1506.4 The University Hospitals of Louvain Experience and Care Pathways for PJIs:

How We Do It . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1566.5 Treatment of Prosthetic Joint Infections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1666.6 Prosthetic Joint Infection: Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1826.7 Dutch Protocol for Treatment of PJIs with Illustrative Clinical Cases . . . . . . . . . . . 189

7 Antibiotic-Loaded Bone Cement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 215

7.1 Benefit and Risks of Antibiotic-Loaded Bone Cements . . . . . . . . . . . . . . . . . . . . 2177.2 Therapy Using Antibiotic- Loaded PMMA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2287.3 The Role of Antibiotic-Loaded Bone Cement in Periprosthetic Joint Infection . . . . . 2377.4 PMMA Cements in Revision Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 243

XII Table of Contents

8 Spacers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 257

8.1 Spacer Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2598.2 Articulating Cement Spacers for the Treatment of Hip and Knee Arthroplasty

Associated Infections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2808.3 Spacer Management in the Treatment of Late Periprosthetic Infections of the Hip . 2948.4 Spacer Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 304

9 Coating . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 311

9.1 Antibacterial Coating of Implants in Orthopaedics and Trauma . . . . . . . . . . . . . . 3139.2 Anti-infective Coating to Prevent Prosthetic Joint Infection . . . . . . . . . . . . . . . . 3289.3 Aspects of Antimicrobial Implant Coating . . . . . . . . . . . . . . . . . . . . . . . . . . . . 337

Servicepart . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 359 Subject Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 360

XIII

List of Contributors

Florian Ludwig AmerstorferDepartment of Orthopaedics and Trauma Surgery, Medical University of GrazAuenbruggerplatz 58036 GrazStyria, Austria FlorianLudwig.Amerstorfer@klinikum-graz.at

Frédéric AuburnDepartment of Anesthesia, Hôpital de la Croix-Rousse, Hospices Civils de Lyon; CRIOAc LyonUniversité Claude Bernard Lyon 1Quai des Célestins 369002 LyonAuvergne-Rhône-Alpes, France frederic.auburn@chu-lyon.fr

Christoph BerberichHeraeus Medical GmbHPhilipp-Reis-Straße 8–1361273 WehrheimHesse, Germany christof.berberich@heraeus.com

James Robert BerstockMusculoskeletal Research Unit, Department of Orthopaedics, Avon Orthopaedic Centre, Southmead Hospital Dorian WayBS10 5NB BristolSouth West England, UK James.Berstock@gmail.com

Isabelle Bobineau Department of Anesthesia, Hôpital de la Croix-Rousse, Hospices Civils de Lyon; CRIOAc LyonUniversité Claude Bernard Lyon 1Quai des Célestins 369002 LyonAuvergne-Rhône-Alpes, France isabelle.bobineau@chu-lyon.fr

Willemijn BootDepartment of Orthopaedics, University Medical Center UtrechtHeidelberglaan 1003584 CX UtrechtUtrecht, The Netherlands W.Boot@umcutrecht.nl

Olivier BorensService d’Orthopédie et de Traumatologie, Centre Hospitalier Universitaire Vaudois (CHUV)Rue de Bugnon 461011 LausanneCanton of Vaud, Switzerland Olivier.Borens@chuv.ch

David G. CampbellWakefield Orthopaedic ClinicUniversity of Adelaide Wakefield Street 2705000 AdelaideSouth Australia, Australia hipknee@tpg.com.au

Jason H. H. ChanRoyal National Orthopaedic Hospital (RNOH) NHS TrustBrockley HilHA7 4LP, StanmoreGreater London, UK jhhchan@doctors.org.uk

Yuhan ChangDivision of Joint Reconstruction, Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, LinkoFuxing Street 5333 Taoyuan CityGuishan District, Taiwan yhchang@cloud.cgmh.org.tw

XIV List of Contributors

Ben ClarkFremantle HospitalAlma Street6160 FremantleWestern Australia, Australia ben.clark@health.wa.gov.au

Elena De VecchiLaboratory of Clinical Chemistry and Microbiology, IRCCS Galeazzi Orthopaedic InstituteVia Festa del Perdono 720122 MilanLombardy, Italy elena.devecchi@grupposandonato.it

Lorenzo DragoLaboratory of Clinical Chemistry and Microbiology, IRCCS Galeazzi Orthopaedic InstituteLaboratory of Clinical Microbiology, Department of Biomedical Sciences for Health, University of MilanVia R. Galeazzi 420161 MilanLombardy, Italy lorenzo.drago@unimi.it

Tristan FerryInfectious Disease Unit, Hôpital de la Croix-Rousse, Hospices Civils de Lyon; CRIOAc LyonUniversité Claude Bernard Lyon 1Quai des Célestins 369002 LyonAuvergne-Rhône-Alpes, France tristan.ferry@chu-lyon.fr

Bernd FinkClinic of Joint Replacement, General and Rheumatic Orthopaedics, Orthopaedic Clinic Markgröningen gGmbHKurt-Lindemann-Weg 1071706 MarkgröningenBaden-Württemberg, Germany Bernd.Fink@okm.de

Lars FrommeltHelios Endo-Klinik HamburgHolstenstraße 222767 HamburgHamburg, Germany lars.frommelt@me.com

Enrico GallazziDepartment of Reconstructive Surgery and Osteo-articular Infections C.R.I.O. Unit - I.R.C.C.S. Galeazzi Orthopaedic InstituteUniversity of MilanVia R. Galeazzi 420161 MilanLombardy, Italy enrico.gallazzi@gmail.com

Thorsten GehrkeHelios Endo-Klinik HamburgHolstenstraße 222767 HamburgHamburg, Germany Thorsten.Gehrke@helios-kliniken.de

Mathias GlehrDepartment of Orthopaedics and Trauma Surgery, Medical University of GrazAuenbruggerplatz 58036 GrazStyria, Austria Mathias.Glehr@klinikum-graz.at

Sascha GraviusClinic for Orthopaedics and Trauma Surgery, Bonn University HospitalSigmund-Freud-Straße 2553105 BonnNorth Rhine-Westphalia, Germany sascha.gravius@ukb.uni-bonn.de

Tim Hanstein Heraeus Medical GmbHPhilipp-Reis-Straße 8–1361273 Wehrheim Hesse, Germany tim.hanstein@heraeus.com

XVList of Contributors

Hans J.G.E. HendriksMáxima Medisch Centrum (MMC)Ds Theodor Fliednerstraat 15631 BM, EindhovenNoord-Brabant, The Netherlands jge_hendriks@hotmail.com

Yannick HerryDepartment of Anesthesia, Hôpital de la Croix-Rousse, Hospices Civils de Lyon; CRIOAc LyonUniversité Claude Bernard Lyon 1Quai des Célestins 369002 LyonAuvergne-Rhône-Alpes, France yannick.herry@chu-lyon.fr

Christopher W. JonesFremantle HospitalUniversity of SydneyAlma Street 6160 FremantleWestern Australia, Australia cjon0040@gmail.com

Tamon KabataDepartment of Orthopaedic Surgery, Graduate School of Medicine, Kanazawa UniversityTakara machi 13-1920-8641 Kanazawa shiIshikawa Prefecture, Japan tamonkabata@yahoo.co.jp

Susann KlimasHeraeus Medical GmbHPhilipp-Reis-Straße 8–1361273 WehrheimHesse, Germany susann.klimas@hotmail.de

Thomas KlugeHeraeus Medical GmbHPhilipp-Reis-Straße 8–1361273 WehrheimHesse, Germany thomas.kluge@heraeus.com

Hendrik KohlhofClinic for Orthopaedics and Trauma Surgery, Bonn University HospitalSigmund-Freud-Straße 2553105 BonnNorth Rhine-Westphalia, Germany Hendrik.Kohlhof@ukb.uni-bonn.de

Andreas KolbHeraeus Medical GmbHPhilipp-Reis-Straße 8–1361273 WehrheimHesse, Germany andreas.kolb@heraeus.com

Klaus-Dieter KühnDepartment of Orthopaedics and Trauma Surgery, Medical University of GrazAuenbruggerplatz 58036 GrazStyria, Austria klaus.kuehn@medunigraz.at

Frederic LaurentMicrobiology Laboratory, Hôpital de la Croix-Rousse, Hospices Civils de Lyon; CRIOAc LyonUniversité Claude Bernard Lyon 1Quai des Célestins 369002 LyonAuvergne-Rhône-Alpes, France frederic.laurent@univ-lyon1.fr

Andreas LeithnerDepartment of Orthopaedics and Trauma Surgery, Medical University of GrazAuenbruggerplatz 58036 GrazStyria, Austria andreas.leithner@medunigraz.at

Elke LiebHeraeus Medical GmbHPhilipp-Reis-Straße 8-1361273 WehrheimHesse, Germany elke.lieb@heraeus.com

XVI List of Contributors

Sébastien LustigOrthopaedic Surgery Unit, Hôpital de la Croix-Rousse, Hospices Civils de Lyon; CRIOAc LyonUniversité Claude Bernard Lyon 1Quai des Célestins 369002 LyonAuvergne-Rhône-Alpes, France sebastien.lustig@chu-lyon.fr

Ashutosh MalhotraHeraeus Medical GmbHPhilipp-Reis-Straße 8–1361273 WehrheimHesse, Germany ashutosh.malhotra@heraeus.com

John McManusService d’Orthopédie et de Traumatologie, Centre Hospitalier Universitaire Vaudois (CHUV)Rue du Bugnon 46CH-1011 LausanneCanton of Vaud, Switzerland John.McManus@chuv.ch

Ilaria MorelliDepartment of Reconstructive Surgery and Osteo-articular Infections C.R.I.O. Unit - I.R.C.C.S. Galeazzi Orthopaedic InstituteUniversity of MilanVia R. Galeazzi 420161 MilanLombardy, Italy ilaria.morelli90@gmail.com

Vincent M. MorettiRothman Institute at Thomas Jefferson University9th Street 125 S PA 19107 PhiladelphiaPennsylvania, USA vincent.moretti@gmail.com

Jeroen G.V. NeytUniversity Hospitals Leuven - Campus PellenbergWeligerveld 13212 LubbeekFlanders, Belgium jeroen.neyt@uzleuven.be

Peter E. OchsnerUniversity of BaselPetersplatz 14003 BaselCanton Basel City, Switzerland peter.ochsner@hin.ch

Dean F.M. PakvisOCON Orthopedic Clinic HengeloGeerdinksweg 1417555 DL HengeloOverijssel, The Netherlands d.pakvis@ocon.nl

Paul F. PartingtonSpire Washington HospitalNorthumbria Healthcare NHS Foundation TrustPicktree LaneNE38 9JZ WashingtonTyne & Wear, UK paul.partington@btopenworld.com

Javad ParviziRothman Institute, Thomas Jefferson University9th Street 125 S PA 19107 PhiladelphiaPennsylvania, USA javadparvizi@gmail.com

Carlo Luca RomanòDepartment of Reconstructive Surgery and Osteo-articular Infections C.R.I.O. Unit – I.R.C.C.S. Galeazzi Orthopaedic InstituteUniversity of MilanVia R. Galeazzi 420161 MilanLombardy, Italy carlo.romano@grupposandonato.it

Vincent RoninPrevention and Infection Control Unit, Hôpital de la Croix-Rousse, Hospices Civils de Lyon; CRIOAc LyonUniversité Claude Bernard Lyon 1Quai des Célestins 369002 LyonAuvergne-Rhône-Alpes, France vincent.ronin@ars.sante.fr

XVIIList of Contributors

Pablo Sanz-RuizOrthopedic and Trauma Service, Gregorio Marañon General University HospitalComplutense UniversityCalle del Dr. Esquerdo 4628007 MadridMadrid, Spain pablo.sanzruiz@gmail.com

Sara ScarponiDepartment of Reconstructive Surgery and Osteo-articular Infections C.R.I.O. Unit – I.R.C.C.S. Galeazzi Orthopaedic InstituteUniversity of MilanVia R. Galeazzi 420161 MilanLombardy, Italy scarponi1981@libero.it

John SegretiUniversity Infectious Diseases, Rush University Medical CenterPaulina St. 600 S. IL 60612 ChicagoIllinois, USA john_segreti@rush.edu

Kiran SingisettiSheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire HospitalGlossop RdS10 2JF SheffieldSouth Yorkshire, UK kiransingisetti@gmail.com

Ralf SkripitzZentrum für Endoprothetik, Fußchirurgie, Kinder - und Allgemeine Orthopädie, Roland-KlinikNiedersachsendamm 72/7428201 BremenBremen, Germany rskripitz@roland-klink.de

Ian StockleySheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire HospitalGlossop RdS10 2JF SheffieldSouth Yorkshire, UK ianstockley56@gmail.com

René H.M. ten BroekeDepartment of Orthopaedic Surgery, Maastricht University Medical CentreP. Debyelaan 256229 HX MaastrichtLimburg, The Netherlands r.tenbroeke@compaqnet.nl

Hiroyuki TsuchiyaDepartment of Orthopaedic Surgery, Graduate School of Medicine, Kanazawa UniversityTakara machi 13-1 920-8641 Kanazawa shiIshikawa Prefecture, Japan tsuchi@med.kanazawa-u.ac.jp

Florent ValourInfectious Disease Unit, Hôpital de la Croix-Rousse, Hospices Civils de Lyon; CRIOAc LyonUniversité Claude Bernard Lyon 1Quai des Célestins 369002 LyonAuvergne-Rhône-Alpes, France florent.valour@chu-lyon.fr

Laura van DommelenMáxima Medisch Centrum (MMC)Ds Theodor Fliednerstraat 15631 BM EindhovenNoord-Brabant, The Netherlands L.vanDommelen@pamm.nl

Robin W.T.M. van KempenMáxima Medisch Centrum (MMC)Ds Theodor Fliednerstraat 15631 BM EindhovenNoord-Brabant, The Netherlands robin.v.kempen@catharinaziekenhuis.nl

XVIII List of Contributors

Manuel Villanueva-MartinezAvanfi - Instituto Avanzado en Medicina Deportiva, Traumatología, Podología y FisioterapiaOrense 3228020 MadridMadrid, Spain mvillanuevam@gmail.com

Anthony VisteOrthopaedic Trauma and Surgery Unit, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon; CRIOAc LyonUniversité Claude Bernard Lyon 1Quai des Célestins 369002 LyonAuvergne-Rhône-Alpes, France viste.anthony@gmail.com

H. Charles VogelyUniversity Medical Center Utrecht, Department of OrthopaedicsHeidelberglaan 1003584 CX UtrechtUtrecht, The Netherlands h.ch.vogely@umcutrecht.nl

Götz von FoersterHelios Endo-Klinik HamburgHolstenstraße 222767 HamburgHamburg, Germany goetz.vonfoerster@helios-kliniken.de

Frank-Christiaan B.M. WagenaarOCON Orthopedic Clinic HengeloGeerdinksweg 1417555 DL HengeloOverijssel, The Netherlands f.wagenaar@ocon.nl

Jason C.J. WebbAvon Orthopaedic Centre, Southmead HospitalDorian WayBS10 5NB BristolSouth West England, UK jcjwebb@doctors.org.uk

Piers YatesDepartment of Orthopaedics and Trauma Fremantle HospitalAlma Street 6160 FremantleWestern Australia, Australia piers.yates@uwa.edu.au