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

Abstract

Background Periprosthetic joint infection after TKA is a challenging complication. Two-stage exchange arthroplasty is the accepted standard of care, but reported failure rates are increasing. It has been suggested this is due to the increased prevalence of methicillin-resistant infections. Questions/purposes We asked the following questions:(1) What is the reinfection rate after two-stage exchange arthroplasty? (2) Which risk factors predict failure? (3) Which variables are associated with acquiring a resistant organism periprosthetic joint infection? Methods This was a case-control study of 102 patients with infected TKA who underwent a two-stage exchange arthroplasty. Ninety-six patients were followed for a minimum of 2 years (mean, 34.5 months; range, 24-90

Sonication of Antibiotic Spacers Predicts Failure during Two-stage Revision for Prosthetic Knee and Hip Infections

“…Two-stage prosthesis exchange with intervening placement of an antibiotic-impregnated polymethylmethacrylate (PMMA) spacer enables local delivery of high concentrations of antibiotic, preserves joint space and joint motion, and maintains patient mobility [5,12]. However, it is not uniformly successful.…”

“…Despite best current practices, investigations have documented reinfection rates as much as 33% [8, 12, and 20]. Recurrence of infection may be more frequent in the setting of resistant organisms such as methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-resistant Staphylococcus epidermidis or in cases requiring multiple prior open procedures [8,11,12,15].…”

“…After a two-stage revision for infection, a prosthetic joint infection may recur or persist, often with the same organism as the index infection [6][7][8]12]. Recurrence may be seen even with negative synovial fluid and intraoperative per prosthetic tissue cultures [2,21].…”

Outcome of One-stage Cementless Exchange for Acute Postoperative Periprosthetic Hip Infection

“…If we had excluded our patients with MRSA infections, our rate of infection control would increase from 70% (19 of 27) to 76% (19 of 25), and the findings would appear more comparable. Other authors have indicated that regardless of the treatment modality, whether I&D [3,7] or one-stage [16] or two-stage exchange [17,19,21,36], infections caused by the more virulent organisms have a higher failure rate. Although our study was underpowered to draw definitive conclusions regarding implant retention based on organism, we are also concerned whether cementless single-stage exchange arthroplasty can control MRSA infection supporting prior authors' results [3,7,14,18] that these patients may best be treated with a two-stage exchange arthroplasty.…”

Clinical Faceoff: One- Versus Two-Stage Exchange Arthroplasty for Prosthetic Joint Infections

“…Drs. Kendoff and Gehrke: There seems to be more and more clinical evidence from the United States showing a relative lower success rates (< 75%) in terms of infection control in multidrug-resistant and culturenegative PJI, especially in the knee [7,8]. Furthermore one current report from the United States describes a high risk of associated mortality (7%) in the two-stage approach for PJI of the hip, with many deaths occurring even before the point of reimplantation [2].…”