Are Patients With a History of Septic Arthritis Undergoing Total Knee Arthroplasty at Higher Risk for Revision Surgery? A Single-Center Study

Ohlmeier, Malte; Delgado, Giorgio; Calderon, Claudia Arias; Hartwig, C.-H.; Gehrke, Thorsten; Citak, Mustafa

doi:10.1016/j.arth.2020.02.065

Cited by 7 publications

(14 citation statements)

References 13 publications

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“…They underline that the time from the initial bone and joint infection 88 E. Portier et al: Arthroplasty after septic arthritis to the arthroplasty was not associated with positive results. That non-negligible rate of positive samples and the good outcomes from Ohlmeier et al (2020) and from our patients after adapted treatment of the identified isolated pathogen underline the importance of systematically obtaining intraoperative specimens. Those samples demonstrate persistent infection, even in patients who clinically appeared to be cured with reassuring preoperative laboratory workups.…”

Section: Discussionmentioning

confidence: 57%

“…For the other cultures, three each grew pathogens differing from those isolated from the SA or led to an a posteriori diagnosis of SA. In the study by Ohlmeier et al (2020), nine (13 %) intraoperative samples grew microorganisms, with subsequent similar antibiotic regimens and no PJIs. The study by Mainard et al (2021) analyzed the benefit of systematic intraoperative sampling during lower-limb arthroplasties after osteoarticular infection in a retrospective study including 92 patients.…”

Section: Discussionmentioning

confidence: 90%

“…Because of the risk of relapse, some teams systematically perform two-stage arthroplasty for patients with prior SA. At the international consensus conference, 85 % of orthopedists opted for two-stage arthroplasty after active SA and one-stage replacement for quiescent infections (Aalirezaie et al, 2019;Ohlmeier et al, 2020;Bauer et al, 2010). Unfortunately, the distinction between active and quiescent infections was not clear and can be difficult to define in practice.…”

Section: Discussionmentioning

confidence: 99%

“…Our study has several limitations. First, its retrospective, monocenter design, with inclusion of a limited number of heterogeneous episodes is limiting, as for most similar investigations (Sultan et al, 2019;Ohlmeier et al, 2020;Bauer et al, 2010;Jerry et al, 1988;Seo et al, 2014;Lee et al, 2002). However, our SA-arthroplasty interval was <5 years and usually <2 years, and we most often treated with onestage arthroplasty with systematic intraoperative sample collection.…”

Section: Discussionmentioning

confidence: 99%

“…PJI was suspected in the presence of persistent joint pain, functional disability, and/or local inflammatory signs or sudden onset of signs of SA on the prosthetic joint. The diagnosis was confirmed by cultures of joint aspirates or intraoperative samples, with at least two isolating the same microorganism, in accordance with international guidelines (Parvizi et al, 2018;Della Valle et al, 2011;Ting and Della Valle, 2017). PJIs were classified either as a relapse of SA on the prosthesis, if the same pathogen as for SA was isolated and if there was no evidence for an acute hematogenous PJI spreading from a distant source of infection, or as a new PJI with a different microorganism.…”

Section: Outcomementioning

confidence: 99%

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Arthroplasty after septic arthritis of the native hip and knee: retrospective analysis of 49 joints

Portier

Zeller

Kerroumi

et al. 2022

J. Bone Joint Infect.

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Abstract. Background: Arthroplasty after septic arthritis (SA) treatment raises diagnostic and therapeutic questions. The main objective was to evaluate infection-free survival of patients undergoing total knee arthroplasty (TKA) or total hip arthroplasty (THA) post-SA. Other objectives were to describe the population's characteristics, surgical strategies, results of preoperative examinations and cultures of intraoperative samples taken at implantation, and postoperative antibiotic therapy. Methods: This is a retrospective, observational, monocenter study, from January 2005 to May 2019, including all patients undergoing TKA or THA with prior or ongoing SA in the same joint. Infection–free survival was analyzed and reported. Results: Forty-seven patients, 29 men, 49 joints operated on (30 knees, 19 hips), were included. Median SA-to-arthroplasty interval was 32 [1–216] weeks. It was <2 years for 43 joints and <6 months for 19 joints. Six patients underwent arthroplasty while still on SA treatment. One-stage arthroplasty was done for 43 joints and two-stage arthroplasty for 6 joints. Eight (16 %) cultures of intraoperative specimens were positive. Median durations of postoperative antibiotic therapy were 10 d for sterile cultures and 82 d for those that were positive. At 2 years, infection-free survival rate was 95.9 % (±0.02). After a median follow-up of 47 [18–142] months, no SA relapse was observed, but five patients developed new periprosthetic joint infections (PJIs) with a different microorganism. Conclusion: Arthroplasty may be a post-SA option, even within a short period of time. One-stage arthroplasty can be done if synovectomy is thorough, intraoperative samples are taken and antibiotics are administered until those culture results become available. We observed no SA relapse, but new PJIs occurred.

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Section: Discussionmentioning

confidence: 57%

Section: Discussionmentioning

confidence: 90%