Prosthetic Joint Infection: A Single-Center Study Comparing Debridement, Antibiotics, Irrigation, and Retention Versus Exchange Arthroplasty

Aims Two-stage exchange arthroplasty is the most common definitive treatment for prosthetic joint infection (PJI) in the USA. Complications that occur during treatment are often not considered. The purpose of this study was to analyze complications in patients undergoing two-stage exchange for infected total knee arthroplasty (TKA) and determine when they occur. Methods We analyzed all patients that underwent two-stage exchange arthroplasty for treatment of PJI of the knee from January 2010 to December 2018 at a single institution. We categorized complications as medical versus surgical. The intervals for complications were divided into: interstage; early post-reimplantation (three months); and late post-reimplantation (three months to minimum one year). Minimum follow-up was one year. In total, 134 patients underwent a first stage of a two-stage exchange. There were 69 males and 65 females with an mean age at first stage surgery of 67 years (37 to 89). Success was based on the new Musculoskeletal Infection Society (MSIS) definition of success reporting. Results Overall, 70 (52%) patients experienced a complication during the planned two-stage treatment, 36 patients (27%) experienced a medical complication and 47 (41%) patients experienced a surgical complication. There was an 18% mortality rate (24/134) at a mean of 3.7 years (0.09 to 8.3). During the inter-stage period, 28% (37/134) of patients experienced a total of 50 complications at a median of 47 days (interquartile range (IQR) 18 to 139). Of these 50 complications, 22 were medical and 28 required surgery. During this inter-stage period, four patients died (3%) and an additional five patients (4%) failed to progress to the second stage. While 93% of patients (125/134) were reimplanted, only 56% (77/134) of the patients were successfully treated without antibiotic suppression (36%, 28/77) or with antibiotic suppression (19%, 15/77) at one year. Conclusion Reported rates of success of two stage exchanges for PJI have not traditionally considered complications in the definition of success. In our series, significant numbers of patients experienced complications, more often after reimplantation, highlighting the morbidity of this method of treatment. Cite this article: Bone Joint J 2020;102-B(6 Supple A):145–150.

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Midterm Results After Tantalum Cones in 1-Stage Knee Exchange for Periprosthetic Joint Infection: A Single-Center Study

The Journal of Arthroplasty ◽

10.1016/j.arth.2019.11.016 ◽

2020 ◽

Vol 35 (4) ◽

pp. 1084-1089

Author(s):

Hussein Abdelaziz ◽

Philipp Biewald ◽

Zoy Anastasiadis ◽

Carl Haasper ◽

Thorsten Gehrke ◽

...

Keyword(s):

Periprosthetic Joint Infection ◽

Joint Infection ◽

Single Center ◽

Midterm Results ◽

Single Center Study ◽

Center Study

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Candida Prosthetic Joint Infection. A Review of Treatment Methods

Journal of Bone and Joint Infection ◽

10.7150/jbji.17699 ◽

2017 ◽

Vol 2 (2) ◽

pp. 114-121 ◽

Cited By ~ 17

Author(s):

Fernando Cobo ◽

Javier Rodríguez-Granger ◽

Antonio Sampedro ◽

Luis Aliaga-Martínez ◽

José María Navarro-Marí

Keyword(s):

Prosthetic Joint Infection ◽

Joint Infection ◽

Favourable Outcome ◽

Antifungal Drugs ◽

Infection Site ◽

Two Stage ◽

Joint Infections ◽

Candidal Infection ◽

Exchange Arthroplasty ◽

Prosthetic Joint

Abstract. Fungal microorganisms are still a rare cause of bone and joint infections. We report a new case of knee prosthetic joint infection due to Candida albicans in a patient with a previous two-stage right knee arthroplasty for septic arthritis due to S. epidermidis occurred several months ago. Moreover, the treatment in 76 cases of Candida prosthetic joint infection has been discussed. Forty patients were female and mean age at diagnosis was 65.7 (± SD 18) yrs. No risk factors for candidal infection were found in 25 patients. Infection site was the knee in 38 patients and hip in 36; pain was present in 44 patients and swelling in 24. The most frequent species was C. albicans, followed by C. parapsilosis. Eleven patients were only treated with antifungal drugs being the outcome favourable in all of them. Two-stage exchange arthroplasty was performed in 30 patients, and resection arthroplasty in other 30; in three patients one-stage exchange arthroplasty was done. A favourable outcome was found in 58 patients after antifungal plus surgical treatment, in 11 after antifungal treatment alone and in one after surgery alone. The type of treatment is still not clearly defined and an algorithm for treatment in fungal PJI should be established, but various types of surgical procedures may be applied.

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Identifying Common Pathogens in Periprosthetic Joint Infection and Testing Drug-resistance Rate for Different Antibiotics: A Prospective, Single Center Study in Beijing

Orthopaedic Surgery ◽

10.1111/os.12394 ◽

2018 ◽

Vol 10 (3) ◽

pp. 235-240 ◽

Cited By ~ 5

Author(s):

Zhang-lai Li ◽

Yun-fei Hou ◽

Bao-qing Zhang ◽

Yi-fan Chen ◽

Qi Wang ◽

...

Keyword(s):

Drug Resistance ◽

Periprosthetic Joint Infection ◽

Joint Infection ◽

Resistance Rate ◽

Single Center ◽

Single Center Study ◽

Center Study

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Non-elective and Revision Arthroplasty Are Independently Associated With Hip and Knee Prosthetic Joint Infection Caused by Acinetobacter Baumannii: a Brazilian Single Center Observational Cohort Study of 98 Patients

10.21203/rs.3.rs-437337/v1 ◽

2021 ◽

Author(s):

Raquel Bandeira Silva ◽

Rodrigo Otavio Araujo ◽

Mauro José Salles

Keyword(s):

Cohort Study ◽

Treatment Failure ◽

Acinetobacter Baumannii ◽

Prosthetic Joint Infection ◽

Joint Infection ◽

Revision Arthroplasty ◽

Rank Test ◽

Single Center ◽

Chronic Infections ◽

Prosthetic Joint

Abstract Background: Prosthetic joint infection (PJI) caused by Acinetobacter baumannii (Ab) has become a growing concern due to its overwhelming ability to express resistance to antibiotics and produce biofilm. Aim: This study aimed to identify independent risk factors (RFs) associated with Ab-PJI and its role in the treatment outcome. Methods: Single-center retrospective, cohort study of PJI patients diagnosed between January 2014 and July 2018. PJI diagnosis was based upon MSIS 2018 criterium. To estimate RFs associated with Ab-PJI, multivariate analyses with level of significance of p < 0.05 was performed. To evaluate treatment failure, the Kaplan–Meier (KM) analysis and log-rank test was performed.Results: Overall, 98 PJI cases were assessed, including 33 with Ab-PJI and 65 with PJI due to other microorganisms (Non-Ab-PJI). Independent RFs associated with Ab-PJI were revision arthroplasty (odds ratio [OR] = 3.01; 95% confidence interval [95% CI] = 1.15–7.90, p = 0.025) and non-elective arthroplasty (OR = 2.65; 95% CI = 1.01–7.01, p = 0.049). Ab-PJI was also more likely to be classified as a chronic late infection (OR = 5.81; 95% CI = 2.1–16.07, p = 0.001) than Non-Ab-PJI. Ab-PJI was not associated with treatment failure (p = 0.557). Conclusions: Late chronic infections, surgical revision, and non-elective arthroplasty are well-known predictors of PJI, but were also independently associated with Ab-PJI. High selective pressure imposed by misuse of antibiotics is likely to have played a role. Infections caused by Ab and surgical treatment with DAIR were not associated with PJI treatment failure. Trial registration: Study data supporting our results were registered at an open access virtual platform for registration of studies on humans performed in Brazil. The Brazilian Registry of Clinical Trials (ReBEC) http://www.ensaiosclinicos.gov.br/rg/RBR-6ft5yb/Register Number: RBR-6ft5yb

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