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Published on: December 3, 2017
Modern treatment of infected total knee arthroplasty with a 2-stage reimplantation protocol
Geoffrey H Westrich1, Sarah Walcott-Sapp, Lindsey J Bornstein
1Department of Orthopedic Surgery, Hospital for Special Surgery, Weill Cornell Medical College, New York, New York 10021, USA.
Abstract:
The purpose of this study was to determine if 2-stage reimplantation for the treatment of infected total knee arthroplasty (TKA) is still effective for treating contemporary pathogens, many of which are multidrug resistant (MDR). The medical records of all cases of infected TKAs from April 1998 to March 2006 were retrospectively reviewed for data on infecting organism and success of treatment. Of 72 patients (75 knees), with a minimum of 2 years of follow-up, who completed the protocol, the infection was eradicated in 90.7% (68/75 knees). Thirty-one (91.2%) of 34 of MDR infections and 42 (91.3%) of 46 of non-MDR infections were successfully treated. These results support previous studies that demonstrated the effectiveness of a 2-stage reimplantation protocol with a standard 1:8 minimal bactericidal titer for treating infections after TKA, including MDR organisms.
Insights
Two-stage reimplantation effectively treats infected total knee arthroplasty (TKA), even with multidrug-resistant (MDR) organisms. This protocol eradicates infection in over 90% of cases, offering a reliable solution for TKA complications.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Biomedical Engineering
Background:
- Total knee arthroplasty (TKA) is a common procedure, but infection remains a significant complication.
- Managing periprosthetic joint infections (PJIs) after TKA is challenging, particularly with the rise of multidrug-resistant (MDR) pathogens.
Purpose of the Study:
- To evaluate the efficacy of a two-stage reimplantation protocol for treating infected total knee arthroplasty (TKA).
- To assess the success rate of this protocol against contemporary pathogens, including multidrug-resistant (MDR) organisms.
Main Methods:
- Retrospective review of medical records for patients who underwent two-stage reimplantation for infected TKA between April 1998 and March 2006.
- Infection eradication rates were analyzed, with a minimum follow-up of 2 years.
- Treatment success was stratified based on the presence of MDR versus non-MDR infecting organisms.
Main Results:
- The two-stage reimplantation protocol achieved an overall infection eradication rate of 90.7% (68/75 knees).
- Success rates were comparable for both multidrug-resistant (MDR) infections (91.2%) and non-MDR infections (91.3%).
- A minimal bactericidal titer of 1:8 was utilized in the treatment protocol.
Conclusions:
- Two-stage reimplantation remains a highly effective treatment strategy for infected total knee arthroplasty (TKA).
- The protocol demonstrates significant success in eradicating infections caused by both multidrug-resistant (MDR) and non-MDR pathogens.
- This supports the continued use of two-stage reimplantation with a 1:8 minimal bactericidal titer for post-TKA infections.
