This article is more than 5 years old. Information may no longer be current.
Two-stage reimplantation effective for TKA infections caused by MRSE, MRSA
Most cases of reinfection that led to failure were caused by a different organism than that seen in the original infection.
Click Here to Manage Email Alerts
Two-stage reimplantation can be an effective treatment option for total knee arthroplasty patients who develop a periprosthetic infection caused by an antibiotic resistant organism, according to a retrospective, multicenter study.
Yogesh Mittal, MD, and colleagues at the OrthoCarolina Hip and Knee Center in Charlotte, N.C., and at the Mayo Clinic in Rochester, Minn., reviewed their results performing two-stage reimplantations in 37 knees that developed a periprosthetic infection caused by either methicillin-resistent Staphylococcus aureus or Staphylococcus epidermidis. They published their findings in the American edition of the Journal of Bone and Joint Surgery.
Patients in the review averaged 70 years of age and were followed for a mean of 51 months.
During the two-stage reimplantation, surgeons used antibiotic-laden cement spacers in 35 of the 37 knees. They also used acrylic cement laden with either vancomycin or an aminoglycoside at the time of reimplantation in 33 of the 37 knees, according to the study.
Patients also received intravenous antimicrobial therapy and oral antibiotics accorduing to the discretion of an infectous disease consultant, which was continued postoperatively until final pathology reports were negative, the authors noted.
Investigators defined a failure as the need for either an arthrodesis, amputation or a reinfection with the same organism.
The investigators found that nine of the 37 patients developed a reinfection. Of these, four (11%) were reinfected with the same organism as the original infection and five (14%) with a different organism, according to the study.
The researchers found no significant associations between reinfection and the length of intravenous antibiotic therapy, duration of antimicrobial therapy or the timing of reimplantation, the authors reported.
"While the overall success rate in our series was only 76%, most (five) of the nine knees that had failure of the reimplantation were reinfected with a different organism. Therefore, we were encouraged that we were successful in eradicating the resistant organisms in this group of patients nearly 90% of the time," the authors wrote.
For more information:
- Mittal Y, Fehring TK, Hanssen A, et al. Two-stage reimplantation for periprosthetic knee infection involving resistant organisms. J Bone Joint Surg Am. 2007;89-A:1227-1231.