Source

Department of Orthopaedic Surgery, NYU Langone Hospital for Joint Diseases, New York, New York, USA. nicholas.ramos@nyumc.org

Abstract

BACKGROUND:

Although the effect of Staphylococcus aureus (SA) decolonization on surgical site infection(SSI) rates has been studied, patient tolerance and acceptance of these regimens has not been assessed. Surgical patients at our hospital's Pre-Admission Testing Clinic (PAT) receive SA reduction protocols instructing the preoperative use of chlorhexidine gluconate (CHG) soap and intranasal mupirocin ointment (MO). Certain insurers do not cover MO costs resulting in out of pocket (OOP) expenses for some patients.

OBJECTIVE:

This study assessed patient attitudes and compliance with our hospital's SA decolonization regimen.

METHODS:

One-hundred-forty-six patients received surveys. Descriptive statistics were used for analysis.

RESULTS:

Of respondents fitting inclusion criteria, 81% followed the MO protocol (MO users) while 89% followed the CHG protocol (CHG users). Fifty-four percent of MO users reported OOP expenses and 13% reported a hard or very hard financial burden. Ninety-three percent of CHG users reported the protocol was easy or very easy to follow.

CONCLUSION:

Eighty-one percent of patients receiving the SA protocol were fully compliant despite cost or difficulty obtaining MO. Given these barriers and some difficulty with CHG application, we hypothesize compliance may be improved if MO is provided to patients without OOP expenses and if the CHG application method is simplified.

Source

Unit of Infectious Diseases, Basel University Medical Clinic, Liestal, Switzerland.

Abstract

The number of knee arthroplasty procedures is growing and projected to further increase. The risk for periprosthetic joint infection (PJI) is estimated to be low (<1%). However, considering the increasing number of total knee arthroplasty, the increasing number of patients with multiple comorbidities, and the lifelong risk for acquiring hematogenous infection, the total number of PJI will further increase. Despite existing treatment concepts for PJI of the knee, there are still questions to solve, such as type of debridement surgery in case of implant retention, the role of a spacer from a microbiological perspective, and the optimal duration of antimicrobial therapy. In this REVIEW, these questions will be analyzed according to the available literature and the experience of the authors. Moreover, we REVIEW the most recent data on infection, risk factors, and microbiology of PJI.

Source

Department of Orthopaedics and Traumatology, Veterans General Hospital, Taipei, Taiwan.

Abstract

INTRODUCTION:

The result of treatment of infections involving antibiotic-resistant organisms in total knee arthroplasty (TKA) is often poor. We evaluated the efficacy of 2-stage revision in TKAs infected with resistant organisms and compared the clinical outcomes with articulating and conventional static spacers, in terms of both infection control and function.

METHODS:

In a prospective manner, from June 2003 to January 2007 selected patients with a TKA infected with resistant organisms were enrolled and treated with 2-stage re-implantation. The 45 patients were divided into 2 groups: group A (23 patients) implanted with the articulating spacers and group S (22 patients) implanted with static spacers. All patients followed the same antibiotic protocols and had the same re-implantation criteria. The efficacy of infection control was evaluated using re-implantation rate, recurrence rate, and overall success rate. The functional and radiographic results were interpreted with the Hospital of Special Surgery (HSS) knee score and the Insall-Salvati ratio.

RESULTS:

With mean 40 (24-61) months of follow-up, 22 of 23 knees were re-implanted in group A and 21 of 22 were re-implanted in group S. Of these re-implanted prostheses, 1 re-infection occurred in group A and 2 occurred in group S. Range of motion after re-implantation, the final functional scores, and the satisfaction rate were better in group A. One third of the patients in group S, and none in group A, had a patella baja.

INTERPRETATION:

After 2-stage re-implantation of TKAs originally infected with resistant organisms, the clinical outcome was satisfactory-and similar to that reported after treatment of TKAs infected with low-virulence strains. Treatment with an articulating spacer resulted in better functional outcome and lower incidence of patella baja.

Source

Department of Anesthesiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA. Boris.Mraovic@jefferson.edu

Abstract

BACKGROUND:

One of the most serious complications after major orthopedic surgery is deep wound or periprosthetic joint infection. Various risk factors for infection after hip and knee replacement surgery have been reported, including patients' comorbidities and surgical technique factors. We investigated whether hyperglycemia and diabetes mellitus (DM) are associated with infection that requires surgical intervention after total hip and knee arthroplasty.

METHODS:

We reviewed our computerized database for elective primary total hip and knee arthroplasty from 2000 to 2008. Demographic information, past medical history of patients, perioperative biochemistry, and postoperative complications were reviewed. Patients were divided into two groups: infected group (101 patients who had surgical intervention for infection at our institution within 2 years after primary surgery) and noninfected group (1847 patients with no intervention with a minimum of one year follow-up. The data were analyzed using t, chi-squared, and Fisher's exact tests.

RESULTS:

There were significantly more diabetes patients in the infected group compared with the noninfected group (22% versus 9%, p < .001). Infected patients had significantly higher perioperative blood glucose (BG) values: preoperative BG (112 ± 36 versus 105 ± 31 mg/dl, p = .043) and postoperative day (POD) 1 BG (154 ± 37 versus 138 ± 31 mg/dl, p < .001). Postoperative morning hyperglycemia (BG >200 mg/dl) increased the risk for the infection more than two-fold. Non-DM patients were three times more likely to develop the infection if their morning BG was >140 mg/dl on POD 1, p = .001. Male gender, higher body mass index, knee arthroplasty, longer operative time and hospital stay, higher comorbidity index, history of myocardial infarction, congestive heart failure, and renal insufficiency were also associated with the infection.

CONCLUSIONS:

Diabetes mellitus and morning postoperative hyperglycemia were predictors for postoperativeinfection following total joint arthroplasty. Even patients without a diagnosis of DM who developed postoperative hyperglycemia had a significantly increased risk for the infection.

© 2011 Diabetes Technology Society.

Source

Department of Orthopedic Surgery, University of Wisconsin Hospitals and Clinics, 600 Highland Ave, Madison, WI 53792-3228, USA. squire@ortho.wisc.edu

Abstract

OBJECTIVE: The purpose of this article is to illustrate how total knee arthroplasty (TKA) and total hip arthroplasty (THA) aspiration by the radiologist can assist the health care team in determining the presence or absence of periprosthetic joint infection. CONCLUSION: The increasing incidence of periprosthetic TKA and THA infection, as well as the changing role of aspiration for diagnosing periprosthetic joint infection, will likely increase demand for this important procedure in the future.

Source

Hospital for Joint Replacement, Tampere, Finland. esa.jamsen@uta.fi

Source

Rothman Institute of Orthopedics, Thomas Jefferson University Hospital, 925 Chestnut Street, Philadelphia, PA 19107, USA.

Abstract

The objective of this study was to evaluate the survivorship of revision TKA and determine the reasons and predictors for failure. Between January 1999 to December 2005, 499 total knee arthroplasty revisions were performed on 474 patients. There were 292 (61.6%) women and 182 (38.4%) men. The average age at the time of index revision was 63.9 years. Revision was defined as surgery in which at least one component (tibial, patellar, femoral, or polyethylene) required exchange. At an average follow-up of 64.8 months (range, 24.1-111.6), and considering reoperation or re-revision as failure, there were 102 failures (18.3%). Infection was the major cause of failure (44.1%) followed by stiffness (22.6%), patellar or extensor mechanism problems (12.8%), periprosthetic fracture (5.9%), loosening (4.9%), haematoma formation (3.9%), malalignment (2.9%), and instability (2.9%). A total of 83% of failures were early (less than two years). Infection was the most common mechanism of failure of revision TKA. The majority of TKA revision failures tend to occur in the first two years after revision. The mode of failure of revision TKA appears to differ from the failure of primary TKA to some extent. Better understanding of current modes by which TKA revisions fail may enable surgeons to prevent these problems and improve outcomes for revision TKA.

Source

Division of Lower Limb Reconstruction and Oncology, Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada.

Abstract

BACKGROUND:

A two-stage revision total knee arthroplasty is recognized as the gold standard in the treatment of infection. However, traditional spacers limit function in the interval between the two stages and may cause instability, scarring, and bone erosion. The PROSTALAC knee spacer is an antibiotic-loaded cement articulating spacer that allows some movement of the knee between stages. Whether motion enhances long-term function is unknown.

QUESTIONS/PURPOSES:

We therefore identify the rate of control of infection using the PROSTALAC exchange spacer and to assess the clinical outcome after implantation with a definitive implant.

METHODS:

We retrospectively reviewed 115 knees that underwent two-stage exchange with the PROSTALAC spacer. Forty-eight of these had a minimum followup of 5 years (mean, 9 years; range, 5-12 years).

RESULTS:

At last review, 101 of the 115 knees (88%) had no evidence of infection. Of the 14 knees that became reinfected, four were from the same organism and 10 were with a different organism. After further intervention, using the two-stage approach again, the infection was controlled in 12 of the 14 initially reinfected cases, resulting in a failure to cure in only two cases. We observed improvements in mean WOMAC, Oxford, UCLA, and Patient Satisfaction scores at last review.

CONCLUSIONS:

The PROSTALAC functional spacer was associated with a 98% rate of control of infectionand improvements in the quality-of-life outcomes in the treatment of chronically infected total knee arthroplasties.

LEVEL OF EVIDENCE:

Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Collaborators (7)

Source

Knoxville Orthopaedic Clinic, Knoxville, TN, USA.

Abstract

BACKGROUND:

Irrigation and débridement is an attractive low morbidity solution for acute periprosthetic kneeinfection. However, the failure rate in the literature is high, averaging 68% (range, 61%-82%). Patients who fail subsequently undergo two-stage reimplantation after a prolonged period of illness. This leads to higher surgical risk and further delays in rehabilitation and may contribute to failure of subsequent revision surgery.

QUESTIONS/PURPOSES:

We determined the rerevision rate due to infection after two-stage reimplantation performed for failed irrigation and débridement of infected TKA.

METHODS:

We performed a multicenter retrospective review of periprosthetic knee infections treated with a two-stage procedure from 1994 to 2008. Selection criteria for the study included initial treatment with irrigation and débridement and subsequent two-stage revision surgery. Failure of two-stage revision was defined as the need for any additional surgery due to infection.

RESULTS:

Of the 83 knees that had undergone previous irrigation and débridement, 28 (34%) failed subsequent two-stage revision and required reoperation for persistent infection.

CONCLUSIONS:

The failure rate in this series of two-stage revisions for periprosthetic knee infection in patients treated with previous irrigation and débridement is considerably higher than previously reported failure rates of two-stage revision. Factors affecting the failure rate may include host quality, thoroughness of débridement, and organism virulence. Patients and surgeons must understand that irrigation and débridement, while initially attractive, may lead to high failure rates of subsequent two-stage reimplantation.

LEVEL OF EVIDENCE:

Level III, therapeutic study. See the guidelines online for a complete description of level of evidence.

Source

The Joint Replacement Center of Korea, Ewha Womans University School of Medicine, MokDong Hospital, 911-1 Mokdong, YangChun-Gu, Seoul 158-710, Korea. younghookim@ewha.ac.kr

Abstract

BACKGROUND:

A classification system with four types of infected TKAs has been commonly used to determine treatment, especially with regard to whether the prosthesis should be removed or retained.

QUESTIONS/PURPOSES:

We asked whether (1) the classification-dictated treatment of the four types ofinfection after TKA would control infection and maintain functional TKA; (2) repeated débridement and two-stage TKA would further improve the infection control rate after initial treatment; and (3) fixation of TKA prosthesis to the host bone was achieved.

METHODS:

We retrospectively reviewed 114 patients with 116 infected TKAs. We determined the infectioncontrol rate after initial treatment, repeated débridement and two-stage TKA. We evaluated the functional and radiographic results using the Knee Society and Hospital for Special Surgery knee scoring systems. The minimum followup was 2 years (mean, 5.6 years; range, 2-8 years).

RESULTS:

The overall infection control rate was 100% in all patients. All patients with early superficial postoperative infection, 94% of patients with early deep postoperative infection, 96% of patients with late chronic infection, and 86% of patients with acute hematogenous infection maintained functioning knee prosthesis at the final followup. One hundred nine of the 114 patients could walk with no or only slight pain and maintained functioning knee prostheses. These 109 patients had stable fixation of the TKA prosthesis to host bone.

CONCLUSIONS:

The techniques proposed by the classification effectively controlled infection and maintained functional TKA with firm fixation of the TKA prosthesis in most patients. Repeated débridement and two-stage TKA further improved the control of infection and functional TKA after initial treatment.

LEVEL OF EVIDENCE:

Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

Source

Orthopaedic Surgery Service, Geneva University Hospitals, Geneva, Switzerland.

Abstract

During a two-stage revision for prosthetic joint infections (PJI), joint aspirations, open tissue sampling and serum inflammatory markers are performed before re-implantation to exclude ongoing silent infection. We investigated the performance of these diagnostic procedures on the risk of recurrence of PJI among asymptomatic patients undergoing a two-stage revision. A total of 62 PJI were found in 58 patients. All patients had intra-operative surgical exploration during re-implantation, and 48 of them had intra-operative microbiological swabs. Additionally, 18 joint aspirations and one open biopsy were performed before second-stage reimplantation. Recurrence or persistence of PJI occurred in 12 cases with a mean delay of 218 days after re-implantation, but only four pre- or intraoperative invasive joint samples had grown a pathogen in cultures. In at least seven recurrent PJIs (58%), patients had a normal C-reactive protein (CRP, < 10 mg/l) level before re-implantation. The sensitivity, specificity, positive predictive and negative predictive values of pre-operative invasive joint aspiration and CRP for the prediction of PJI recurrence was 0.58, 0.88, 0.5, 0.84 and 0.17, 0.81, 0.13, 0.86, respectively. As a conclusion, pre-operative joint aspiration, intraoperative bacterial sampling, surgical exploration and serum inflammatory markers are poor predictors of PJI recurrence. The onset of reinfection usually occurs far later than reimplantation.

Source

Paracelsus Medical Privatuniversity, Salzburg, Austria.

Abstract

BACKGROUND:

Clinical characteristics and control of the infection of patients with culture-negative (CN) prosthetic joint infection (PJI) have not been well assessed. Prior use of antimicrobial therapy has been speculated but not proven as a risk factor for CNPJI.

QUESTIONS/PURPOSES:

We therefore determined whether prior use of antimicrobial therapy, prior PJI, and postoperative wound healing complications were associated with CN PJI.

METHODS:

We performed a retrospective case-control study of 135 patients with CN PJI treated between January 1, 1985, and December 31, 2000 matched with 135 patients with culture-positive (CP) PJIs (control patients) during the study period. The time to failure of therapy compared between cases and control patients using a Kaplan-Meier analysis.

RESULTS:

The use of prior antimicrobial therapy and postoperative wound drainage after index arthroplasty were associated with increased odds of PJI being culture-negative (odds ratio, 4.7; 95% CI, 2.8-8.1 and odds ratio, 3.5; 95% CI, 1.5-8.1, respectively). The percent (+/- SE) cumulative incidence free of treatment failure at 2 years followup was similar for CN and CP PJI: 75% (+/- 4%) and 79% (+/- 4%), respectively.

CONCLUSIONS:

Prior antimicrobial therapy and postoperative wound drainage were associated with an increased risk of negative cultures among patients with PJI. Physicians should critically evaluate the need for antimicrobial therapy before establishing a microbiologic diagnosis of PJI in patients with suspected PJI.

LEVEL OF EVIDENCE:

Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Source

University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.

Abstract

BACKGROUND:

The incidence of infection by methicillin-resistant Staphylococcus aureus (MRSA) in total knee arthroplasty (TKA) is becoming a more frequent concern, as increased morbidity following TKA has been reported for infections by resistant organisms. This study investigates whether MRSA infections are associated with decreased functional scores.

QUESTIONS/PURPOSES:

We therefore compared the functional scores, operative times, and rates of reinfection of revision TKA following MRSA infection versus other indications for revision.

METHODS:

We retrospectively reviewed charts of 101 patients (103 knees) who underwent mobile bearing TKA revision from January 2003 to September 2006, with a minimum clinical followup of 2 years in 45 knees (44%). We obtained the following indices: WOMAC, Activities of Daily Living Score (ADLS), SF-36, and Knee Society scores (KSS). Three groups of revisions were compared: MRSA infection (n = 6), non-MRSA infection(n = 9), and aseptic failure (n = 30). The three groups were similar in demographics and comorbidities.

RESULTS:

The MRSA (166 minutes) and non-MRSA groups (149 minutes) had longer operative times than the aseptic group (121 minutes). With numbers available, there were no differences in ROM, WOMAC, ADLS, KSS, and SF-36, with MRSA separate or combined with all infections. Infection recurrence between MRSA-infected knees and non-MRSA-infected knees was similar.

CONCLUSIONS:

While our study was underpowered to detect functional differences between MRSA-infected knees and non-MRSA-infected knees it does add data to the literature. Knees revised for infection have longer operative times and more frequent infection after revision. The reason for increased operative times is unclear.

LEVEL OF EVIDENCE:

Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

Source

Department of Orthopaedic Surgery, Imam University Hospital, Tehran University of Medical Sciences, End of Keshavarz Blvd, Tehran 1419733141, Iran.

Abstract

BACKGROUND:

Deep infection remains one of the most devastating and costly complications after total knee arthroplasty (TKA). The risk of deep infection after revision TKA is reportedly greater than that for primary TKA; however, we do not know the exact incidence of infection after revision TKA.

QUESTIONS/PURPOSES:

We determined the incidence of infection after revision, the type of microorganisms involved and TKA, and the potential risk factors for this infection.

METHODS:

We retrospectively reviewed 475 patients (476 knees) with 499 TKA revisions performed between March 1998 and December 2005. Of the 476 knees, 91 (19%) were revised for infection and 385 (81%) were revised for aseptic failure. Preoperative history, results of physical examinations, laboratory and radiographic results, joint fluid aspiration results along with analysis of intraoperative findings were all considered to make an assessment of septic versus aseptic failure modes. Patients were followed for a minimum of 25 months (mean, 65 months; range, 25-159 months).

RESULTS:

Deep infection developed in 44 of the 476 knees (9%). The infection rate was higher in patients undergoing revision for infection than in patients with aseptic revisions: 21% (23 of 91) and 5% (21 of 385), respectively. Revision for infection, higher Charlson index, and diagnosis other than osteoarthritis at the time of primary TKA predicted infection of the revision. The risk of infection for patients undergoing TKA revisions was 10-fold higher than for patients undergoing primary TKA at our institution.

CONCLUSIONS:

Infection of primary TKA is the most important risk factor for subsequent infection of TKA revisions.

LEVEL OF EVIDENCE:

Level III, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

Source

University College London Hospital, London, UK. geertmeermans@hotmail.com

Abstract

BACKGROUND:

Successful treatment of an infected joint arthroplasty depends on correctly identifying the responsible pathogens. The value of a preoperative biopsy remains controversial.

QUESTIONS/PURPOSES:

We (1) compared the sensitivity and specificity of both tests separately and in combination, and (2) asked whether the combination of tissue biopsy and aspiration would improve our diagnostic yield in the evaluation of periprosthetic joint infections.

PATIENTS AND METHODS:

We prospectively followed 120 patients with suspected infection of a total joint arthroplasty: 64 with THAs and 56 with TKAs. All patients had aspiration with culture and biopsy.

RESULTS:

The sensitivity was 83% for aspiration, 79% for biopsy, and 90% for the combination of both techniques. The specificity was 100% for aspiration and biopsy and the combination. The overall accuracy was 84%, 81%, and 90%, respectively.

CONCLUSIONS:

Our data suggest tissue biopsy alone offers no clear advantage over joint aspiration. However, the combination of both techniques provides improved sensitivity and accuracy. We recommend the use of tissue biopsy as an adjunct to joint aspiration in the diagnosis of total joint infection.

LEVEL OF EVIDENCE:

Level II, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence.

Source

Knee and Lower Limb Institute, University of Marseille, Marseille, France. michel.assor@free.fr

Abstract

BACKGROUND:

I conducted a prospective study to assess the effectiveness of an absorbable calcium hydroxyapatite (Hac) layer mixed with vancomycin applied to the articular surface of prosthetic implants in preventing deep infections after noncemented total knee arthroplasty (TKA). This severe complication of TKA occurs in 2%-7% of cases.

METHODS:

In all, 135 consecutive noncemented TKAs were performed in 126 patients, who were divided into 2 groups. Group 1 comprised 73 knees that received a noncemented implant without any local anti-infectiontreatment. Group 2 comprised 62 knees that received a noncemented implant with the local anti-infectionagent, which consisted of a pasty mixture of 2 g absorbable Hac and 1-2 g vanco mycin. The paste was spread in a thin layer on the articular surface of the implants. Patients in both groups received systemic antibiotic therapy.

RESULTS:

In group 1 (no local anti-infection agent), there were 3 deep infections (4.1%) in the early (< 2 mo) or intermediate (2 mo to 2 yr) period after surgery, but no signs of loosening. The infections were treated by arthroscopic debridement and antibiotic therapy. There were no infections or loosening of joints in group 2.

CONCLUSION:

This study shows that a local anti-infection treatment is an effective supplement to systemic antibiotic therapy for the prevention of deep infections in noncemented TKA.

Source

Department of Medicine, Division of Infectious Diseases, Mayo Clinic College of Medicine, Rochester, MN 55905, USA. berbari.elie@mayo.edu

Erratum in

• Clin Infect Dis. 2010 Mar 15;50(6):944.

Abstract

BACKGROUND:

The actual risk of prosthetic joint infection as a result of dental procedures and the role of antibiotic prophylaxis have not been defined.

METHODS:

To examine the association between dental procedures with or without antibiotic prophylaxis and prosthetic hip or knee infection, a prospective, single-center, case-control study for the period 2001-2006 was performed at a 1200-bed tertiary care hospital in Rochester, Minnesota. Case patients were patients hospitalized with total hip or knee infection. Control subjects were patients who underwent a total hip or knee arthroplasty but without a prosthetic joint infection who were hospitalized during the same period on the same orthopedic floor. Data regarding demographic features and potential risk factors were collected. Logistic regression was used to assess the association of variables with the odds of infection.

RESULTS:

A total of 339 case patients and 339 control subjects were enrolled in the study. There was no increased risk of prosthetic hip or knee infection for patients undergoing a high-risk or low-risk dental procedure who were not administered antibiotic prophylaxis (adjusted odds ratio [OR], 0.8; 95% confidence interval [CI], 0.4-1.6), compared with the risk for patients not undergoing a dental procedure (adjusted OR, 0.6; 95% CI, 0.4-1.1) respectively. Antibiotic prophylaxis in high-risk or low-risk dental procedures did not decrease the risk of subsequent total hip or knee infection (adjusted OR, 0.9 [95% CI, 0.5-1.6] and 1.2 [95% CI, 0.7-2.2], respectively).

CONCLUSIONS:

Dental procedures were not risk factors for subsequent total hip or knee infection. The use of antibiotic prophylaxis prior to dental procedures did not decrease the risk of subsequent total hip or kneeinfection.

Comment in

• Oral cavity staphylococci are a potential source of prosthetic joint infection. [Clin Infect Dis. 2010]
• Antibiotics for prevention of periprosthetic joint infection following dentistry: time to focus on data. [Clin Infect Dis. 2010]

Source

Exponent, Inc, 3401 Market Street, Suite 300, Philadelphia, PA 19104, USA.

Abstract

The current risk of infection in contemporary total knee arthroplasty (TKA) as well as the relative importance of risk factors remains under debate as a result of the rarity of the complication and temporal changes in the treatment and prevention of infection. We therefore determined infection incidence and risk factors after TKA in the Medicare population. The Medicare 5% national sample administrative data set was used to identify and longitudinally follow patients undergoing TKA for deep infections and revision surgery between 1997 and 2006. Cox regression was used to evaluate patient and hospital characteristics. In 69,663 patients undergoing elective TKA, 1400 TKA infections were identified. Infection incidence within 2 years was 1.55%. The incidence between 2 and up to 10 years was 0.46%. Women had a lower risk of infection than men. Comorbidities also increased TKA infection risk. Patients receiving public assistance for Medicare premiums were at increased risk for periprosthetic joint infection (PJI). Hospital factors did not predict an increased risk of infection. PJI occurs at a relatively high rate in Medicare patients with the greatest risk of PJI within the first 2 years after surgery; however, approximately one-fourth of all PJIs occur after 2 years. LEVEL OF EVIDENCE: Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

Source

Department of Orthopedic Surgery, Rothman Institute of Orthopedics at Thomas Jefferson University Hospital, 925 Chestnut St, Philadelphia, PA 19107, USA. parvj@rothmaninstitute.com

Abstract

Prosthetic joint infections (PJI) caused by methicillin-resistant staphylococci represent a major therapeutic challenge. We examined the effectiveness of surgical treatment in treating infection of total hip or knee arthroplasty caused by methicillin-resistant staphylococcal strains and the variables influencing treatment success. One hundred and twenty-seven patients were treated at our institution between 1999 and 2006. There were 58 men and 69 women, with an average age of 66 years. Patients were followed for a minimum of 2 years or until recurrence of infection. Débridement and retention of the prosthesis was performed in 35 patients and resection arthroplasty in 92. Débridement controlled the infection in only 37% of cases whereas two-stage exchange arthroplasty controlled the infection in 75% of hips and 60% of knees. Preexisting cardiac disease was associated with a higher likelihood of failure to control infection in all treatment groups. Antibiotic-resistant Staphylococci continue to compromise treatment outcome of prosthetic joint infections, especially in patients with medical comorbidities. New preventive and therapeutic strategies are needed. LEVEL OF EVIDENCE: Level IV, therapeutic study.