Results of 2-stage reimplantation for infected total knee arthroplasty

Two-stage Exchange Knee Arthroplasty: Does Resistance of the Infecting Organism Influence the Outcome?

“…We believe the need for further surgery and administration of prolonged therapeutic or suppressive antibiotics should be considered a failure. Our time to reinfection (66 weeks), reinfection with a methicillin-resistant organism (50%), and reinfection with the same organism as the index infection (56%) are consistent with data from other studies [5,6,8,16]. These findings suggest our higher reinfection rate is unlikely the result of intraoperative or early postoperative management of the patients as we did not see a rise in acute infections and were similarly competent at controlling the index organism.…”

“…However, we believe our findings provide valuable information to patients in making informed decisions about their healthcare, help physicians in appropriate patient selection and through further research create opportunities to develop tailored protocols for these patients. Our reinfection rate (27%) after two-stage exchange arthroplasty is on the high end of what is reported in the literature (Table 8) [5,6,8,16]. This may be explained by our study representing a worst-case scenario: although only 19 of the 26 patients who were classified as reinfected underwent subsequent resection arthroplasty, any additional surgery after the initial reimplantation, even if the prosthesis was retained, was considered a failure.…”

“…Previous studies [6,8,11,12,16] have demonstrated lower satisfaction ratings among patients, increased number of surgical procedures (3.9 per patient) and lower rates of controlling infections (18-76%) in the setting of methicillin-resistant organism infections after primary TKA. The largest published study [6], 96 knees in 94 patients, did not find methicillin-resistant organism infections to be associated with failure of two-stage exchange but suggested this likely represented a Type II statistical error.…”

“…Multiple studies have evaluated this treatment protocol and identified a variety of factors associated with failure [1-4, 6-12, 16, 17, 20, 23-26]. These include increased number of comorbidities, previous surgery, and initial diagnosis of rheumatoid arthritis versus osteoarthritis [8,16]. Although virulence of the infecting organism has been presumed to be a risk factor for reinfection, these studies were not able to demonstrate causation between infection with a methicillin-resistant organism and failure of two-stage exchange arthroplasty.…”

“…This is concerning to the orthopaedic community as multiple studies have reported lower success rates (18-76%) in treating resistant organism PJI [6,8,12,16]. However, it is unclear whether the increased failure rate after two-stage exchange arthroplasty is associated with the virulence of the infecting organism.…”