Success Rates for Initial Eradication of Peri-prosthetic Knee Infection Treated with a Two-stage Procedure

Infection is one of the most serious complications after total knee arthroplasty (TKA). The current incidence of prosthetic knee infection is 1-3%, depending on the series.For treatment and control to be more cost effective, multidisciplinary groups made up of professionals from different specialities who can work together to eradicate these kinds of infections need to be assembled. About the microbiology,Staphylococcus aureusand coagulase-negative staphylococcus were among the most frequent microorganisms involved (74%).Anamnesis and clinical examination are of primary importance in order to determine whether the problem may point to a possible acute septic complication. The first diagnosis may then be supported by increased CRP and ESR levels. The surgical treatment for a chronic prosthetic knee infection has been perfectly defined and standardized, and consists in a two-stage implant revision process. In contrast, the treatment for acute prosthetic knee infection is currently under debate. Considering the different surgical techniques that already exist, surgical debridement with conservation of the prosthesis and polythene revision appears to be an attractive option for both surgeon and patient, as it is less aggressive than the two-stage revision process and has lower initial costs.The different results obtained from this technique, along with prognosis factors and conclusions to keep in mind when it is indicated for an acute prosthetic infection, whether post-operative or haematogenous, will be analysed by the authors.

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Tibial Tubercle Osteotomy or Quadriceps Snip in Two-stage Revision for Prosthetic Knee Infection? A Randomized Prospective Study

Clinical Orthopaedics and Related Research ◽

10.1007/s11999-012-2763-z ◽

2013 ◽

Vol 471 (4) ◽

pp. 1305-1318 ◽

Cited By ~ 18

Author(s):

Danilo Bruni ◽

Francesco Iacono ◽

Bharat Sharma ◽

Stefano Zaffagnini ◽

Maurilio Marcacci

Keyword(s):

Prospective Study ◽

Tibial Tubercle ◽

Tibial Tubercle Osteotomy ◽

Two Stage ◽

Knee Infection ◽

Prosthetic Knee ◽

Prosthetic Knee Infection

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Image-guided in situ detection of bacterial biofilms in a human prosthetic knee infection model: a feasibility study for clinical diagnosis of prosthetic joint infections

European Journal of Nuclear Medicine and Molecular Imaging ◽

10.1007/s00259-020-04982-w ◽

2020 ◽

Author(s):

Jorrit W. A. Schoenmakers ◽

Marjolein Heuker ◽

Marina López-Álvarez ◽

Wouter B. Nagengast ◽

Gooitzen M. van Dam ◽

...

Keyword(s):

Optical Imaging ◽

Bacterial Species ◽

Bacterial Biofilms ◽

Infection Model ◽

Knee Infection ◽

Prosthetic Knee ◽

Image Guided ◽

Prosthetic Joints ◽

Prosthetic Joint Infections ◽

Prosthetic Knee Infection

Abstract Purpose Due to an increased human life expectancy, the need to replace arthritic or dysfunctional joints by prosthetics is higher than ever before. Prosthetic joints are unfortunately inherently susceptible to bacterial infection accompanied by biofilm formation. Accurate and rapid diagnosis is vital to increase therapeutic success. Yet, established diagnostic modalities cannot directly detect bacterial biofilms on prostheses. Therefore, the present study was aimed at investigating whether arthroscopic optical imaging can accurately detect bacterial biofilms on prosthetic joints. Methods Here, we applied a conjugate of the antibiotic vancomycin and the near-infrared fluorophore IRDye800CW, in short vanco-800CW, in combination with arthroscopic optical imaging to target and visualize biofilms on infected prostheses. Results We show in a human post-mortem prosthetic knee infection model that a staphylococcal biofilm is accurately detected in real time and distinguished from sterile sections in high resolution. In addition, we demonstrate that biofilms associated with the clinically most relevant bacterial species can be detected using vanco-800CW. Conclusion The presented image-guided arthroscopic approach provides direct visual diagnostic information and facilitates immediate appropriate treatment selection.

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