Conservative Treatment of Staphylococcal Prosthetic Joint Infections in Elderly Patients

195

125

Prosthetic joint infections (PJI) caused by methicillin-resistant staphylococci represent a major therapeutic challenge. We examined the effectiveness of surgical treatment in treating infection of total hip or knee arthroplasty caused by methicillin-resistant staphylococcal strains and the variables influencing treatment success. One hundred and twenty-seven patients were treated at our institution between 1999 and 2006. There were 58 men and 69 women, with an average age of 66 years. Patients were followed for a minimum of 2 years or until recurrence of infection. Débridement and retention of the prosthesis was performed in 35 patients and resection arthroplasty in 92.

Section: Discussionsupporting

confidence: 80%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Periprosthetic Infection Due to Resistant Staphylococci: Serious Problems on the Horizon

Parvızı

Azzam²,

Ghanem³

et al. 2009

195

125

“…Half of our patients had infection with methicillin-resistant organisms that persisted despite delayed reimplantation. Infection with such organisms compromises the treatment outcome [2,13]. The majority of our patients also had medical comorbidities.…”

Section: Discussionmentioning

confidence: 93%

Outcome of a Second Two-stage Reimplantation for Periprosthetic Knee Infection

Azzam

McHale

Austin

et al. 2009

102

Recurrent or persistent infection after two-stage exchange arthroplasty for previously infected total knee replacement is a challenging clinical situation. We asked whether a second two-stage procedure could eradicate the infection and preserve knee function. We evaluated 18 selected patients with failed two-stage total knee arthroplasty implantation treated with a second two-stage reimplantation between 1999 and 2005. Failure of treatment was defined as recurrence or persistence of infection. The minimum followup was 24 months (mean, 40 months; range, 24-83 months). Recurrent or persistent infection was diagnosed in four of 18 patients, two of whom were successfully treated with a third two-stage exchange arthroplasty. Knee Society score questionnaires administered at the last followup showed an average Knee Society knee score of 73 points (range, 24-100 points) and an average functional score of 49 points (range, 20-90 points). The data suggest repeat two-stage exchange arthroplasty is a reasonable option for eradicating periprosthetic infection, relieving pain, and achieving a satisfactory level of function for some patients.

“…Published series of arthroplasty infections describe a lower likelihood of eradicating infection when it is caused by multiresistant organisms [1, 14-16, 20, 23, 27]. Some of these studies report rates of eradication of infection but do not evaluate the functional orthopaedic outcomes of the patients [1,14,16,20,23,27]. Eradication of infection and functional outcomes in polymicrobial infections have been less studied [14,18,20].…”

Section: Introductionmentioning

confidence: 99%

Oral Antibiotics are Effective for Highly Resistant Hip Arthroplasty Infections

Cordero‐Ampuero

Esteban

García-Cimbrelo

2009

Infected arthroplasties reportedly have a lower eradication rate when caused by highly resistant and/or polymicrobial isolates and in these patients most authors recommend intravenous antibiotics. We asked whether two-stage revision with interim oral antibiotics could eradicate these infections. We prospectively followed 36 patients (mean age, 71.8 years) with late hip arthroplasty infections. Combinations of oral antibiotics were prescribed according to cultures, biofilm, and intracellular effectiveness. The minimum followup was 1 year (mean, 4.4 years; range, 1-12 years). We presumed eradication in the absence of clinical, serologic, and radiographic signs of infection. Infection was eradicated in all 13 patients with highly resistant bacteria who completed a two-stage protocol (10 with methicillin-resistant Staphylococci) and in eight of 11 patients treated with only the first stage (and six of nine with methicillin-resistant Staphylococci). Infection was eradicated in six of six patients with polymicrobial isolates (of sensitive and/or resistant bacteria) who completed a two-stage protocol and in five of seven with polymicrobial isolates treated with only the first surgery. The Harris hip score averaged 88.1 (range, 70-98) in patients who underwent reimplantation and 56.8 (range, 32-76) in patients who underwent resection arthroplasty.