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Updated: Jan 13, 2026
Novel Diagnostics in Revision Arthroplasty: Implant Sonication and Multiplex Polymerase Chain Reaction
Published on: December 3, 2017
[Revision Arthroplasty for Periprosthetic Femoral Fracture Complicated by Multidrug-Resistant Escherichia coli: Case
Jaroslav Kraus1, Vlasta Krausová2, Hynek Bartoš3
1Ortopedicka klinika Fakulty zdravotnickych studii Univerzity J. E. Purkyne v Usti nad Labem a Krajske zdravotni a. s. - Masarykovy nemocnice v Usti nad Labem, o. z.
Abstract:
Periprosthetic infections caused by multi-resistant bacteria are one of the most fearsome complications in current orthopedics. Despite using aseptic modern practices, the number of infectious complications caused by multidrug-resistant strains is rising worldwide. We present a case of a woman with a non-healing wound after hip arthroplasty revision surgery performed in Egypt for periprosthetic femoral fracture. Upon admission, 11 days after surgery, she presented with a purulent secretion from surgical wound and signs of sepsis. Carbapenem-resistant E. coli was proven from a wound swab. Two-stage revision with a 6-week-long interval of targeted parenteral antibiotic therapy was indicated. During explantation, excessive femoral bone loss after inadequately performed trauma revision surgery was discovered. After antibiotic hip spacer period, the patient underwent implantation of a cemented tumorous revision hip implant followed by 6 weeks of antibiotic therapy. The patient was discharged in more than satisfactory condition, being self-sufficient using French crutches. In follow-up visits during next 2 years, no relapse of carbapenem-resistant infection occurred. In patients hospitalized or operated in high-risk areas, epidemiological anamnesis is of great importance and the possibility of importing multi-resistant bacteria should be considered. Infections caused by these bacteria prolong therapy and increase the cost of treatment significantly. The combination of arthroplasty extraction and targeted antibiotic therapy is recommended to treat periprosthetic infections.
Insights
Multi-resistant bacteria cause severe periprosthetic infections. A two-stage revision surgery with targeted antibiotics successfully treated a carbapenem-resistant E. coli infection after hip arthroplasty.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Microbiology
Background:
- Periprosthetic joint infections (PJIs) are a significant challenge in orthopedics.
- The incidence of multidrug-resistant (MDR) bacterial infections is increasing globally.
- Aseptic techniques do not fully prevent infectious complications.
Purpose of the Study:
- To report a case of successful management of a complex periprosthetic infection.
- To highlight the challenges posed by carbapenem-resistant bacteria in orthopedic surgery.
- To emphasize the importance of epidemiological history in high-risk areas.
Main Methods:
- A two-stage surgical revision was performed for a hip arthroplasty revision complicated by periprosthetic femoral fracture.
- A carbapenem-resistant E. coli infection was identified and treated with targeted parenteral antibiotics.
- An antibiotic hip spacer was used during the interval period, followed by cemented tumorous revision hip implant and further antibiotic therapy.
Main Results:
- The patient presented with purulent wound discharge and sepsis 11 days post-surgery.
- Excessive femoral bone loss was noted during explantation.
- The patient recovered well, with no signs of infection relapse during a 2-year follow-up.
Conclusions:
- Periprosthetic infections caused by MDR bacteria require prolonged and complex treatment.
- Arthroplasty extraction combined with targeted antibiotic therapy is an effective treatment strategy.
- Considering epidemiological history is crucial for managing potential MDR bacterial importations.
