Infections associated with percutaneous osseointegrated titanium implants for limb prostheses
Bibliographic record
Abstract
Femoral amputation is a devastating event. Percutaneous, bone anchored\nprosthetic systems reduce problems associated with socket suspended\nprostheses, but the design is inherently vulnerable to infection. The aims of\nthis thesis were to determine the risk of implant-associated infection, bacterial\nbiofilm properties and the functional impact using this implant treatment\nregime. Definition of implant related osteomyelitis was based on clinical\nsigns, radiography and positive tissue cultures. In 3-year prospective study 39\npatients were evaluated twice for infectious frequency, clinical presentation,\nand its relation to bacterial flora at the skin-implant interface (Paper 1). The\nfrequency of implant infection was 5% at inclusion and 18% at follow-up. The\nmost common bacteria in superficial, and deep cultures were Staphylococcus\naureus and coagulase-negative staphylococci. Despite frequent colonization\nby potentially virulent bacteria, limited disability, and only one implant\nremoval was found. Phenotypical and genotypical biofilm formation was\ndetermined in 13 (7 staphylococcal, 6 enterococcal) osteomyelitis strains\n(Paper II). Antimicrobial resistance was tested with a novel combination of\nthe Calgary biofilm MBEC device, and a custom-made susceptibility MIC\nplate. The majority of the strains produced biofilm with increased\nantimicrobial resistance, compared to their planktonic counterparts. Slime\nproducing strains tolerated higher antimicrobial concentrations compared to\nnon-producers. All staphylococcal strains carried ica genes. The long-term\nrisk of implant-associated infection, and its relation to patient and method\nspecific factors was determined in a 20-year retrospective analysis of the first\n96 femoral implant patients (102 implants) (Paper III). A 10-year cumulative\nrisk of 20% for developing osteomyelitis (16 patients), and a 10-year\ncumulative risk of 9 % for implant extraction due to osteomyelitis (10 patients)\nwas found. Antibiotic treatment (median 3.5 months) and selective minor\ndebridement, with retained implants, cured 7 out of 18 patients at the 24-\nmonth follow-up (Paper IV). Six patients were cured after implant extraction,\nand 5 had chronic low-grade infections with stable implants, but variable use\nof the external prosthetic leg. The most common pathogens were S. aureus\nand E. faecalis. C-reactive protein serum levels were significantly higher in\npatients with osteomyelitis caused by S. aureus than other pathogens. It is\nconcluded that the finding of an increased risk of osteomyelitis with time using\nthis implant system calls for; i) careful patient selection and information of\nlong term risks, ii) further studies on infection control, iii) consideration of\nbiofilm in treatment, and iv) improved diagnostics, and antibiotic delivery.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.003 | 0.001 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".