Infection remains a serious clinical problem in orthopaedic surgery, as approximately 112,000 orthopaedic device-related infections occur every year in the US alone, with an estimated increase in hospital costs of $15,000-30,000 per incident. While the infection rates over the past decade have been only 2% and 5% for joint prosthesis and fracture-fixation devices, respectively, > 80% of which are caused by Staphylococcus, these problems typically require a very costly and complicated two-stage reconstruction technique to first remove the infected devices and tissues and control the infection using antibiotic-laden cement spacers or beads , before attempting to replace the hardware. Moreover, this two-stage approach is associated with failure rates as high as 50% with catastrophic results that could lead to arthrodesis, amputation or death.
This AOTrauma sponsored Clinical Priority Program (CPP) team proposes a multi-faceted approach to Infection, to address the problem in an innovative, comprehensive, and effective manner. This CPP consortium proposes eight projects to address the Prevention, Diagnosis, Treatment, Documentation and Basic Science of orthopaedic infections. The problem is complex and multifactorial, therefore it is difficult to understand how these infections can happen so often in the 21st century. We will study the evidence-based Best Practices to Prevent Infection and create a scalable template for Education in all regions. We will develop a diagnostic test to demonstrate the patient’s immunity to Staphylococcus infections. We will develop a 3-D printed antibiotic ceramic spacer in an animal model. We will study the treatment efficacy of a passive vaccine against Staph. including MRSA in vitro (Rochester), rats and rabbits (Giessen) and sheep (ARI, Davos), using novel models of implant-associated osteomyelitis (OM) that closely resemble the clinical situation. We will analyze current clinical treatment protocols in patients suffering from serious bone and joint infections with AOCID. To disseminate best practices and our results, we propose a comprehensive six-part Educational Program in conjunction with AOTrauma Education. Finally, in this CPP, we will create with AOCID an Infection Registry to help with the study of infection cases in a standardized manner in conjunction with AOCID. Only with such a comprehensive approach to the problem can we conquer Staphylococcus infections in a five year period.
For investigators in the Registry Project, the data/specimen collection video can be seen below.
For questions regarding this project, please contact Dr. Stephen Kates.