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Published on: December 3, 2017
Two-stage reimplantation for periprosthetic knee infection involving resistant organisms
Yogesh Mittal1, Thomas K Fehring, Arlen Hanssen
1OrthoCarolina Hip and Knee Center, Charlotte, North Carolina 28270, USA.
Background:
Two-stage reimplantation is the most accepted mode of treatment for patients with a periprosthetic infection following total knee arthroplasty. Most studies, however, do not stratify their results on the basis of the type of infecting organism. The purpose of this study was to determine the outcomes for patients who had two-stage reimplantation for the treatment of infection with a resistant organism, methicillin-resistant Staphylococcus aureus or methicillin-resistant Staphylococcus epidermidis, at the site of a total knee replacement.
Methods:
A multicenter study was performed to review the cases of all patients treated between 1987 and 2003 because of an infection with methicillin-resistant Staphylococcus aureus or methicillin-resistant Staphylococcus epidermidis organisms at the site of a total knee replacement. The prevalence of reinfection following two-stage reimplantation was determined. Variables that may influence the outcome, such as the duration and type of intravenous antibiotics administered, previous surgery, and comorbidities of the host, were analyzed.
Results:
We identified thirty-seven patients who had an infection with a resistant organism. All patients had negative cultures at the time of reimplantation. Four of the thirty-seven patients had a reinfection with the same organism, while five had a reinfection with a different organism. None of the variables noted above were found to be significantly associated with reinfection, on the basis of the numbers available.
Conclusions:
Reports in the literature have discouraged reimplantation for the treatment of an infection with a resistant organism at the site of a total knee replacement. While 24% of the patients in this series had a reinfection, 14% had a reinfection with a different organism. We believe that two-stage reimplantation remains a viable treatment option for patients who have an infection with a resistant organism at the site of a total knee replacement.
Level Of Evidence:
Therapeutic Level IV.
Insights
Two-stage reimplantation is a viable treatment for total knee replacement infections caused by resistant organisms like MRSA and MRSE. Despite a 24% reinfection rate, this approach offers a successful option for patients facing challenging infections.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Biomedical Engineering
Background:
- Periprosthetic joint infection (PJI) following total knee arthroplasty (TKA) is a serious complication.
- Two-stage reimplantation is the standard treatment for TKA PJI.
- Outcomes are often not stratified by specific resistant organisms.
Purpose of the Study:
- To evaluate the outcomes of two-stage reimplantation for TKA PJI caused by methicillin-resistant Staphylococcus aureus (MRSA) or methicillin-resistant Staphylococcus epidermidis (MRSE).
- To determine the reinfection rate and identify factors influencing outcomes in these specific patient populations.
Main Methods:
- A multicenter retrospective study reviewed patients treated for MRSA or MRSE TKA PJI between 1987 and 2003.
- The prevalence of reinfection after two-stage reimplantation was assessed.
- Potential influencing variables including antibiotic therapy, prior surgeries, and comorbidities were analyzed.
Main Results:
- Thirty-seven patients with resistant organism infections were identified, all with negative cultures at reimplantation.
- Four patients (10.8%) experienced reinfection with the same organism, and five (13.5%) with a different organism.
- No analyzed variables were significantly associated with reinfection.
Conclusions:
- Previous literature discouraged reimplantation for resistant organism TKA PJI.
- Despite a 24% overall reinfection rate (14% with a different organism), two-stage reimplantation is considered a viable treatment option.
- This approach offers a potential solution for patients with challenging TKA infections.
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