scholarly journals One-Stage Implant-Retaining Revision for Simultaneous Bilateral Infected Total Knee Arthroplasty: A Report of a Rare Case

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Nils Wirries ◽  
Lars-René Tuecking ◽  
Michael Skutek
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Rare Case ◽  
Joint Infection ◽  
Joint Fluid ◽  
Total Knee Arthroplasties ◽  
Joint Infections ◽  
Infected Total Knee Arthroplasty ◽  
Irrigation And Debridement ◽  
Total Knee

There is little information on the management of simultaneous infected total knee arthroplasties in the same patient. Although general principles of management for periprosthetic joint infection apply, there might be certain aspects worth to be considered. We present a case of a 78-year-old patient, who was referred in preseptic conditions 10 years following bilateral TKA. The onset of symptoms was less than one week, proposing an acute hematogenous infection. Analysis of joint fluid revealed that both of his TKAs were infected with Streptococcus sanguinis. Diagnostic algorithms, surgical principles, and the course of the patients following bilateral revision are being described. The reasons for an implant-retaining procedure with irrigation and debridement including the exchange of the polyethylene liners are being discussed as well as possible principles of management of bilateral periprosthetic joint infections.

Outcomes of single- and two-stage revision total knee arthroplasty for chronic periprosthetic joint infection

2021 ◽  
Vol 103-B (8) ◽  
pp. 1373-1379
Author(s):  
Hosam E. Matar ◽  
Benjamin V. Bloch ◽  
Susan E. Snape ◽  
Peter J. James
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Joint Infection ◽  
Recurrent Infection ◽  
Primary Outcome Measure ◽  
Revision Total Knee Arthroplasty ◽  
Single Stage ◽  
Two Stage ◽  
Joint Infections ◽  
Total Knee

Aims Single-stage revision total knee arthroplasty (rTKA) is gaining popularity in treating chronic periprosthetic joint infections (PJIs). We have introduced this approach to our clinical practice and sought to evaluate rates of reinfection and re-revision, along with predictors of failure of both single- and two-stage rTKA for chronic PJI. Methods A retrospective comparative cohort study of all rTKAs for chronic PJI between 1 April 2003 and 31 December 2018 was undertaken using prospective databases. Patients with acute infections were excluded; rTKAs were classified as single-stage, stage 1, or stage 2 of two-stage revision. The primary outcome measure was failure to eradicate or recurrent infection. Variables evaluated for failure by regression analysis included age, BMI, American Society of Anesthesiologists grade, infecting organisms, and the presence of a sinus. Patient survivorship was also compared between the groups. Results A total of 292 consecutive first-time rTKAs for chronic PJI were included: 82 single-stage (28.1%); and 210 two-stage (71.9%) revisions. The mean age was 71 years (27 to 90), with 165 females (57.4%), and a mean BMI of 30.9 kg/m2 (20 to 53). Significantly more patients with a known infecting organism were in the single-stage group (93.9% vs 80.47%; p = 0.004). The infecting organism was identified preoperatively in 246 cases (84.2%). At a mean follow-up of 6.3 years (2.0 to 17.6), the failure rate was 6.1% in the single-stage, and 12% in the two-stage groups. All failures occurred within four years of treatment. The presence of a sinus was an independent risk factor for failure (odds ratio (OR) 4.97; 95% confidence interval (CI) 1.593 to 15.505; p = 0.006), as well as age > 80 years (OR 5.962; 95% CI 1.156 to 30.73; p = 0.033). The ten-year patient survivorship rate was 72% in the single-stage group compared with 70.5% in the two-stage group. This difference was not significant (p = 0.517). Conclusion Single-stage rTKA is an effective strategy with a high success rate comparable to two-stage approach in appropriately selected patients. Cite this article: Bone Joint J 2021;103-B(8):1373–1379.

Current Insights in the Evaluation and Treatment of Infected Total Knee Arthroplasty

2021 ◽  
Author(s):  
Blair S. Ashley ◽  
Javad Parvizi
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Difficult Problem ◽  
Postoperative Course ◽  
Infected Total Knee Arthroplasty ◽  
Treatment Considerations ◽  
Total Knee

AbstractTotal knee arthroplasty is a widely successful procedure, but a small percentage of patients have a postoperative course complicated by periprosthetic joint infection (PJI). PJI is a difficult problem to diagnose and to treat, and the management of PJI differs, depending on the acuity of the infection. This paper discusses the established and newer technologies developed for the diagnosis of PJI as well as different treatment considerations and surgical solutions currently available.

scholarly journals Non-Hodgkin Lymphoma Mimics Infected Total Knee Arthroplasty

2018 ◽  
Vol 24 (1) ◽  
pp. 25-28
Author(s):  
Lo Chi-Kin ◽  
Lai Chun-Kit ◽  
Tsang Koon-Ho ◽  
Wong Yiu-Chung
Keyword(s):  
Total Knee Arthroplasty ◽  
Hodgkin Lymphoma ◽  
Knee Arthroplasty ◽  
Joint Infection ◽  
Revision Arthroplasty ◽  
B Cell Lymphoma ◽  
Pathology Report ◽  
Non Hodgkin Lymphoma ◽  
Infected Total Knee Arthroplasty ◽  
Total Knee

Lymphoma associated with total knee arthroplasty is a rare condition. We report a case of non-Hodgkin lymphoma mimicking an infected total knee arthroplasty. A 73-year-old woman who received left total knee replacement presented with fever and a discharging sinus over her left knee 12 weeks after surgery. The diagnosis of prosthetic joint infection was made and a two-stage revision arthroplasty planned. After implant removal and insertion of an antibiotic spacer in the first-stage operation, culture results of all intraoperative specimens were negative but the pathology report showed diffuse large B-cell lymphoma. She then received chemotherapy and a second-stage reconstruction operation. The wound healed uneventfully and she regained independent mobility.

Infected Total Knee Arthroplasty by Brucella melitensis: A Rare Case Report

2016 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Mahmoud Jabalameli ◽  
Abolfazl Bagherifard ◽  
Hosseinali Hadi ◽  
Iman Qomashi
Keyword(s):  
Total Knee Arthroplasty ◽  
Case Report ◽  
Knee Arthroplasty ◽  
Rare Case ◽  
Brucella Melitensis ◽  
Infected Total Knee Arthroplasty ◽  
Rare Case Report ◽  
Total Knee

Infected total knee arthroplasty treated by arthroscopic irrigation and débridement

2000 ◽  
Vol 15 (4) ◽  
pp. 430-436 ◽  
Author(s):  
Barry J Waldman ◽  
Emmanuel Hostin ◽  
Michael A Mont ◽  
David S Hungerford
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Infected Total Knee Arthroplasty ◽  
Irrigation And Debridement ◽  
Total Knee

scholarly journals Prognostic Factors for Success After Irrigation and Debridement With Modular Component Exchange for Infected Total Knee Arthroplasty

2018 ◽  
Vol 33 (7) ◽  
pp. 2240-2245 ◽  
Author(s):  
Christian M. Klare ◽  
Thomas A. Fortney ◽  
Peter W. Kahng ◽  
Andrew P. Cox ◽  
Benjamin J. Keeney ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Prognostic Factors ◽  
Knee Arthroplasty ◽  
Infected Total Knee Arthroplasty ◽  
Irrigation And Debridement ◽  
Total Knee ◽  
Modular Component

Total Knee Arthroplasty: The Efficacy of Calcium Sulfate Beads in One-Stage Aseptic Revision

2019 ◽  
pp. 1-5
Author(s):  
Ronald E. Delanois ◽  
James Nace ◽  
Joseph O. Ehiorobo
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Surgical Outcome ◽  
Calcium Sulfate ◽  
Joint Infection ◽  
Revision Total Knee Arthroplasty ◽  
One Stage ◽  
Irrigation And Debridement ◽  
Aseptic Revision ◽  
Total Knee

Background: The risk of periprosthetic joint infection following revision total knee arthroplasty is high, as is the cost of care. Decreasing periprosthetic joint infection risk may include utilization of calcium sulfate beads. Calcium sulfate beads have been gaining momentum in treating infected joints because of their potential advantages, including antibiotic elution and dissolvability. However, literature documenting their utilization in aseptic revision is sparse. This study compares: 1) infection rates; 2) length of stay; 3) subsequent infection procedures; and 4) final surgical outcome between one-stage aseptic revision total knee arthroplasty patients who received calcium sulfate beads and those who did not. Methods: We performed a retrospective chart review to identify patients who underwent aseptic one-stage revision total knee arthroplasty between January 2013 and December 2017. Outcomes collected included postoperative infection rate, length of stay, subsequent irrigation and debridement, and final surgical outcome, classified as a successful total knee arthroplasty reimplantation, a retained antibiotic spacer, or an above knee amputation. Chi-square analysis was used to analyze all categorical variables, while Student’s t-testing was used for continuous variables. A p-value of 0.5 was set as the threshold for statistical significance. Results: Calcium sulfate bead patients did not differ from non-calcium sulfate bead patients with regard to the number of postoperative infections (p=0.103), lengths of stay (p=0.210), irrigation and debridement procedures (p=0.063) and surgical outcome (p=0.085). Conclusion: Patients who received calcium sulfate beads had analogous surgical outcomes and infection rates to non-calcium sulfate bead patients. The use of calcium sulfate beads in aseptic one-stage revision total knee arthroplasty may not be beneficial in preventing infection and reducing costs.

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