Long-Term Suppression of Infection in Total Joint Arthroplasty

Abstract

Optimal treatment for a chronic infected prosthesis is the removal of infected and necrotic tissue and all the components of the prosthesis with staged revision in conjunction with systemic antibiotics. If this is not possible because of the poor general condition of the patient, because of unacceptable functional results secondary to removal of the prosthesis, or because the patient refuses surgery in an attempt to salvage the infected prosthesis, a reasonable alternative is long-term oral suppressive antibiotic therapy for maintenance of a functioning prosthesis. Prompt recognition with rapid debridement and initiation of antibiotic therapy seems crucial. Our study confirms a favorable outcome of maintenance of functioning prostheses in 86.2% of patients after a mean followup of 5 years. All patients had initial debridement with 4 to 6 weeks of systemic antibiotic therapy. Advanced age did not seem to predict poor outcome. Joint location, duration of symptoms, and the time of onset of infection did not predict success or failure. The overall success rate for Staphylococcus aureus prosthetic joint infection was 69% after a mean followup of 5 years. The ideal regimen and optimal duration of oral suppressive therapy for a favorable outcome is not well-established and needs additional data with prospective multicenter studies.

Vancomycin covalently bonded to titanium alloy prevents bacterial colonization

“…The modified Ti surface continued to exhibit potent antibacterial activity after preincubation with serum proteins and after more than 45 days of incubation in a physiological buffer. This latter time point is of some importance as patients with PPI are normally treated with antibiotics for 4-6 weeks 33 ; the antibiotic-modified Ti implant is active, at the very minimum, for that time period. We are currently evaluating long-term activity of the Ti-Vanc.…”

Better Function for Fusions Versus Above-the-knee Amputations for Recurrent Periprosthetic Knee Infection

“…The rate of recurrence ranges from 9% to 33% [21,23,26,33,39,40,49,57,59], and the treatment options for treating patients who have failed multiple revision TKAs are limited to revision TKA [52], long-term antibiotic suppression [44], fusion [2-4, 6, 10, 11, 13, 14, 22, 28, 34, 35, 42, 43, 47, 54], above-the-knee amputation (AKA) [17,30,41,51], and resection arthroplasty [52]. Patients who undergo resection arthroplasty often do not have good function after surgery [50], and this surgery is usually performed for severely medically compromised patients [52].…”

“…The SF-12 physical component summary measurements were higher for fusions (51) than for AKAs (26). The mental component summary was also higher in fusions (60) than in AKAs (44). Seventy percent of patients indicated they would undergo a fusion again instead of undergoing an amputation if they were presented with both options after undergoing their operation.…”

Infection in Primary Hip and Knee Arthroplasty

“…Rifampicin/ciprofloxacin combination was successful in all patients compared to 58% of patients who received ciprofloxacin alone . Subsequent studies corroborated these results with success rates of greater than 85% of patients treated with debridement and retention and rifampicin containing antibiotic treatment (Berdal, et al 2005, Rao, et al 2003. The main limitations with the use of rifampicin are the high likelihood of generation of resistance when used without a second antibiotic and the hepatic and gastrointestinal toxicities (John, et al 2009, Widmer, et al 1990).…”