Two-stage reimplantation for periprosthetic knee infection involving resistant organisms

Yogesh Mittal, Thomas K. Fehring, Aden Hanssen, Camelia Marculescu, Susan M. Odum, Douglas Osmon

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140 Scopus citations

Abstract

Background: Two-stage reimplantation is the most accepted mode of treatment for patients with a periprosthetic infection following total knee arthroplasty. Most studies, however, do not stratify their results on the basis of the type of infecting organism. The purpose of this study was to determine the outcomes for patients who had two-stage reimplantation for the treatment of infection with a resistant organism, methicillin-resistant Staphylococcus aureus or methicillin-resistant Staphylococcus epidermidis, at the site of a total knee replacement. Methods: A multicenter study was performed to review the cases of all patients treated between 1987 and 2003 because of an infection with methicillin-resistant Staphylococcus aureus or methicillin-resistant Staphylococcus epidermidis organisms at the site of a total knee replacement. The prevalence of reinfection following two-stage reimplantation was determined. Variables that may influence the outcome, such as the duration and type of intravenous antibiotics administered, previous surgery, and comorbidities of the host, were analyzed. Results: We identified thirty-seven patients who had an infection with a resistant organism. All patients had negative cultures at the time of reimplantation. Four of the thirty-seven patients had a reinfection with the same organism, while five had a reinfection with a different organism. None of the variables noted above were found to be significantly associated with reinfection, on the basis of the numbers available. Conclusions: Reports in the literature have discouraged reimplantation for the treatment of an infection with a resistant organism at the site of a total knee replacement. While 24% of the patients in this series had a reinfection, 14% had a reinfection with a different organism. We believe that two-stage reimplantation remains a viable treatment option for patients who have an infection with a resistant organism at the site of a total knee replacement. Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

Original languageEnglish (US)
Pages (from-to)1227-1231
Number of pages5
JournalJournal of Bone and Joint Surgery - Series A
Volume89
Issue number6
DOIs
StatePublished - Jun 2007

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ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Mittal, Y., Fehring, T. K., Hanssen, A., Marculescu, C., Odum, S. M., & Osmon, D. (2007). Two-stage reimplantation for periprosthetic knee infection involving resistant organisms. Journal of Bone and Joint Surgery - Series A, 89(6), 1227-1231. https://doi.org/10.2106/JBJS.E.01192