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Published on: December 3, 2017
Concomitant Multiple Joint Arthroplasty Infections: Report on 16 Cases
Valérie Zeller1, Delphine Dedome2, Luc Lhotellier3
1Service de Chirurgie Osseuse et Traumatologique, Groupe Hospitalier Diaconesses Croix Saint-Simon, Paris, France; Centre de Référence des Infections Ostéo-Articulaires Complexes, Groupe Hospitalier Diaconesses Croix Saint-Simon, Paris, France; Service de Médecine Interne et Rhumatologie, Groupe Hospitalier Diaconesses Croix Saint-Simon, Paris, France.
Background:
Concomitant infections of several prostheses are very rare, serious events that pose particular medical and surgical therapeutic challenges. This study was undertaken to describe epidemiologic, clinical, and microbiological characteristics of concomitant multiple joint arthroplasty infections, their treatments, and outcomes.
Methods:
Retrospective (January 2000 and January 2014), single-center, cohort study in a referral center for bone and joint infections. All patients with at least 2 concomitant, microbiologically documented, prosthetic joint infections, that is, during the same septic episode, were included.
Results:
Sixteen patients were included. Median (range) age was 78 years (46-93 years), gender ratio was 1, and median (range) body mass index was 27 (21-42). Multiple joint arthroplasties (bilateral hip in 8 patients; bilateral knee in 3 patients; hip and knee in 1 patient; and 2 knees and 1 hip in 1 patient) were contaminated hematogenously in all patients, 2 after early postoperative infections. Eight Staphylococcus aureus, 1 Staphylococcus epidermidis, 6 Streptococcus, and 1 Escherichia coli strains were isolated. A curative strategy was applied to 11 patients: 3 underwent bilateral synovectomies, 6 had successive 1-stage exchange arthroplasties, and 2 were treated with other strategies. After 37 months (range, 24-132 months) of follow-up, reinfection occurred in 1 patient. The 5 other patients received prolonged suppressive antibiotic therapy.
Conclusion:
These complex infections occur during staphylococcal or streptococcal bacteremia. Treatment strategies should be discussed by a multidisciplinary team on a case-by-case basis.
Insights
Multiple prosthetic joint infections are rare but serious, often stemming from staphylococcal or streptococcal bacteremia. Treatment requires a multidisciplinary approach, with surgical intervention and antibiotic therapy showing good outcomes.
Area of Science:
- Orthopedics
- Infectious Diseases
- Surgical Infections
Background:
- Concomitant multiple prosthetic joint infections are rare, serious events.
- These infections present significant medical and surgical therapeutic challenges.
- Understanding their characteristics is crucial for effective management.
Purpose of the Study:
- To describe the epidemiologic, clinical, and microbiological features of concomitant multiple joint arthroplasty infections.
- To detail the treatment strategies employed for these complex cases.
- To report the outcomes of patients with multiple prosthetic joint infections.
Main Methods:
- Retrospective, single-center cohort study (January 2000 - January 2014).
- Inclusion criteria: patients with at least two concomitant, microbiologically documented prosthetic joint infections during the same septic episode.
- Data collected on patient demographics, infection characteristics, treatment, and outcomes.
Main Results:
- Sixteen patients were included, with a median age of 78 years.
- Hematogenous contamination was the primary route, often associated with Staphylococcus aureus or Streptococcus species.
- Curative strategies included synovectomies and 1-stage exchange arthroplasties, with a low reinfection rate (1/11 patients).
Conclusions:
- Concomitant prosthetic joint infections frequently occur during staphylococcal or streptococcal bacteremia.
- Effective treatment necessitates a case-by-case discussion by a multidisciplinary team.
- Individualized treatment plans are essential for managing these challenging infections.
