Arthroscopic debridement in the treatment of the infected total knee replacement

Dixon, Paul; Parish, E. N.; Cross, Mervyn J.

doi:10.1302/0301-620x.86b1.14399

Cited by 62 publications

(33 citation statements)

References 11 publications

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“…The option of debridement with implant retention harbours a higher risk of infection recurrence than procedures with implant removal, especially for knee PJIs [1,2]. Provided that the duration of infection is shorter than two to four weeks, there is no sinus tract, implant loosening or methicillin resistance among staphylococci [1,3,4], the debridement and irrigation approach may also be a valid alternative for elderly patients with less bone stock [5] and multiple co-morbidities, for whom anaesthesia and surgery could be harmful [1].…”

Section: Introductionmentioning

confidence: 99%

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Pathogen-driven decision for implant retention in the management of infected total knee prostheses

Zürcher-Pfund

Uçkay

Legout

et al. 2013

International Orthopaedics (SICOT)

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Purpose In prosthetic joint infections (PJIs) of the knee, debridement with implant retention is associated with a high risk of recurrence. Methods A single-centre cohort study was performed with extensive analysis of the literature covering 1980-2012. Results In 21 patients (mean age 80.4 years, 19 immunosuppressed), in association with 1.5-three months of antibiotic treatment, an attempt was made to salvage the prosthesis by open (11 patients) or arthroscopic (ten patients) debridement. After a mean follow-up of seven years (range four-20 years), patients were in remission in seven cases (33 %). Remission was achieved in 0 % of all methicillin-resistant Staphylococcus aureus (MRSA) infections (zero/three), in 0 % (zero/three) of methicillin-resistant coagulase-negative staphylococcal infections, in 29 % (two/seven) of methicillin-sensitive S. aureus infections and in 75 % (three/four) of infections due to streptococci. The literature review focused on implant preserving approaches yielded 599 cases with an overall success rate of 47 % (284/599) and significantly more remissions in streptococcal vs staphylococcal knee PJIs (43/54 vs 144/324; p< 0.01, odds ratio 4.9, 95 % confidence interval 2.4-10.9).Conclusions In addition to established indications for explantation such as implant loosening, sinus tract or methicillin resistance, the decision for debridement and retention of knee PJIs should also depend on the pathogen. Implant preservation is futile with methicillin-resistant staphylococci, but seems to be a valid option for streptococcal PJIs.

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Section: Introductionmentioning

confidence: 99%

“…Many of these papers have substantial shortcomings. They mix up hip and knee arthroplasties [10,12], reveal short minimal follow-up times of only several months [4,11,13,16,17], report less than ten cases [8,13,[18][19][20] or report only specific pathogens [7,9] such as methicillinresistant Staphylococcus aureus (MRSA) [1,3].…”

Section: Introductionmentioning

confidence: 99%

Pathogen-driven decision for implant retention in the management of infected total knee prostheses

Zürcher-Pfund

Uçkay

Legout

et al. 2013

International Orthopaedics (SICOT)

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“…Antibiotic suppression [8], joint lavage [9], debridement with exchange of polyethylene liner [10], and complete revision [11][12][13], are all strategies which have been employed to manage deep infection. In severe cases arthrodesis [14] or even amputation [15] are sometimes required when all other options fail.…”

Section: Introductionmentioning

confidence: 99%

The microbiology of the infected knee arthroplasty

Nickinson

Board

Gambhir

et al. 2009

International Orthopaedics (SICOT)

102

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We describe the results of a retrospective analysis of patients with microbiologically proven infection, who underwent revision TKA between 1994 and 2008. Of the 121 patients included in the study, 61 (50%) were male and 60 (50%) were female. The mean age was 71 (range 42-88) years. The most common organisms identified were Coagulase negative Staphylococcus (CNS) (49%) and Staphylococcus aureus (SA) (13%). The prevalence of CNS appears to be increasing, while that of SA and other organisms is decreasing. Vancomycin and teicoplanin were the most effective antibiotics with overall sensitivity rates of 100% and 96%, respectively. The results of our theoretical model suggest that gentamicin combined with vancomycin is the most effective empirical regimen. Staphylococcal species are the most common organisms encountered in deep infection of the knee. Gentamicin combined with vancomycin offers the most comprehensive protection and potentially allows for infected knee arthoplasties to be treated with a one-stage procedure.

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“…There are several options to treat an infected knee replacement, the choice of which depends on the time of onset, the microorganism, and radiological exams. These options range from prosthesis retention [13] for early infections up to revision arthroplasty, resection arthroplasty, and arthrodesis.…”

Section: Introductionmentioning

confidence: 99%

Custom-made Articulating Spacer in Two-stage Revision Total Knee Arthroplasty. An Early Follow-up of 14 Cases of at Least 1 Year after Surgery

Pascale

2007

HSS Journal®: The Musculoskeletal Journal of Hospital for Speci

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Total knee replacement (TKR) infection represents only a small percentage of all the potential complications in joint replacement, but one that can lead to disastrous consequences. Two-stage revision, which has been proven to be the most effective technique in eradicating infection, includes prosthesis removal, positioning of an antibiotic-loaded spacer, and systemic antimicrobial therapy for at least 6 weeks. It has been suggested that there is better performance in terms of range of motion, pain, extensor mechanism shortening, and spacer-related bone loss if articulating spacers are used instead of fixed spacers. In this paper, we describe our results in two-stage revision of infected total knee arthroplasty with a minimum follow-up of 12 months on 14 patients treated by antibiotic-loaded custommade articulating spacer as described by Villanueva et al. (Acta Orthop 77(2):329-332, 2006). The mean flexion achieved after the second stage of the revision was 120-, ranging from 97-to 130-. The mean Hospital for Special Surgery score was 84. At 1 year after surgery, none of the knees showed any evidence of recurrence of the infection. Articulating spacers are a suitable alternative to fixed spacers with good range of motion after reimplantation and effectiveness against total knee replacement deep infections.

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Arthroscopic debridement in the treatment of the infected total knee replacement

Cited by 62 publications

References 11 publications

Pathogen-driven decision for implant retention in the management of infected total knee prostheses

Pathogen-driven decision for implant retention in the management of infected total knee prostheses

The microbiology of the infected knee arthroplasty

Custom-made Articulating Spacer in Two-stage Revision Total Knee Arthroplasty. An Early Follow-up of 14 Cases of at Least 1 Year after Surgery

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