Two-stage reimplantation for periprosthetic knee infection: Influence of host health status and infecting microorganism

Tigani, Domenico; Trisolino, Giovanni; Fosco, M.; Ayad, R. Ben; Costigliola, Paolo

doi:10.1016/j.knee.2012.06.004

Cited by 40 publications

(35 citation statements)

References 39 publications

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“…Tigani et al . reported in their study that in the face of positive intraoperative cultures recurrence of infection was 83% compared to 12.5% with negative intraoperative cultures [30]. Similarly, we observed a higher rate of successful two-stage revision in the absence of methicillin-resistant staphylococcus infection.…”

Section: Discussionsupporting

confidence: 77%

Treatment Failure Among Infected Periprosthetic Patients at a Highly Specialized Revision TKA Referral Practice

Schwarzkopf¹,

Oh²,

Wright³

et al. 2013

TOORTHJ

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Deep infection is a serious and costly complication of total knee arthroplasty (TKA), which can increase patient morbidity and compromise functional outcome and satisfaction. Two-stage revision with an interval of parental antibiotics has been shown to be the most successful treatment in eradicating deep infection following TKA.We report a large series by a single surgeon with a highly specialized revision TKA referral practice.We identified 84 patients treated by a two-stage revision. We defined “successful two-stage revision” as negative intraoperative cultures and no further infection-related procedure. We defined “eradication of infection” on the basis of negative cultures and clinical diagnosis.After a mean follow up of 25 months, eradication of the infection was documented in 90.5% of the patients; some had undergone further surgical intervention after the index two-stage procedure. Successful two-stage revision (e.g. no I&D, fusion, amputation) was documented only in 63.5% of the patients. We also observed a trend between presence of resistant staphylococcus (MRSA) (p=0.05) as well as pre-revision surgical procedures (p=0.08) and a lower likelihood of successfully two-stage revision.Factors affecting the high failure rate included multiple surgeries prior to the two-stage revision done at our institution, and high prevalence of MRSA present among failed cases.The relatively high rate of failure to achieve a successful two-stage revision observed in our series may be attributed to the highly specialized referral practice. Thus increasing the prevalence of patients with previous failed attempts at infection eradication and delayed care as well as more fragile and immune compromised hosts.

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Section: Discussionsupporting

confidence: 77%

Treatment Failure Among Infected Periprosthetic Patients at a Highly Specialized Revision TKA Referral Practice

Schwarzkopf¹,

Oh²,

Wright³

et al. 2013

TOORTHJ

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“…Once the infection is eradicated, and CRP and ESR levels return to normal, the second surgery is performed to remove the spacer and implant the revision prosthesis. The latter approach may be performed in most cases of PJI [16,17] and has a success rate ranging from 37.1 to 100 % [18][19][20].…”

Section: This Article Is Part Of the Topical Collection On Revision Kmentioning

confidence: 99%

The use of spacers (static and mobile) in infection knee arthroplasty

Mazzucchelli

Rosso

Marmotti

et al. 2015

Curr Rev Musculoskelet Med

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Revision total knee arthroplasty (TKA) is the treatment of choice in patients with periprosthetic joint infection. It may be performed in either a single stage or two stages. In the latter option, between stages, an antibiotic-loaded spacer may be used to maintain a certain amount of joint stability and mobility after the infected implant is removed, adding an intra-articular concentration of antibiotics. There are two types of antibiotic-loaded cement spacers: static and dynamic. Static spacers basically create a temporary arthrodesis with antibiotic-loaded cement and usually are handmade within the surgical field. Dynamic spacers can be created intraoperatively by using different tools or may be prepackaged by the manufacturer; they allow range of motion between stages. In this article, the authors review the indications, surgical techniques, and results for static and dynamic spacers in two-stage revision TKA.

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“…The latest work by Gausden et al (5) showed us how the nonunions of the clavicle are very often related to a latent infection and to saprophytic microorganisms of the surgical site (25). Also from the data collected by us we saw that many patients in the preoperative had a high number of comorbidities and postoperatively had dental treatment or infections of other systems that may have been the source of contamination (26)(27)(28). Therefore it is useful, before proceeding to a surgery for a nonunion, to do a careful history and physical examination to discern what type of symptoms and disability, if any, the patient is experiencing.…”

mentioning

confidence: 76%

The challenge of nonunion after osteosynthesis of the clavicle: is it a biomechanical or infection problem?

Rollo¹

2017

ccmbm

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SummaryIntroduction. The nonunion rate has been reported between 0.1% and 15%. There are also several predisposing factors for the onset of complications: general factors connected with the patient and specific factors related to the fracture site. The purpose of our study is to review the etiology of nonunion of the clavicle in its atrophic form and investigate the outcomes of the revision treatment in a single step. Materials and methods. Retrospective study on 71 patients suffering from nonunions due to the following treatments: conservative in 13 patients; plate fixation in 12; closed reduction and fixation with K-wire in 24; open reduction and fixation with K-wire. All patients were operated on in beach chair position and classic approach to the clavicle by incising the previous surgical scar. The clinical and radiographic criteria for evaluating the outcomes were: the Short Form (12) Health Survey (SF-12), the Constant Shoulder Score (CSS) and the Disability Disabilities of the Arm, Shoulder and Score (DASH) and radiographic Union Score (RUS) for bone healing. The evaluation endpoint was set at 12 months. Results. Blood and culture tests showed 22 infected nonunions and 49 atrophic or oligoatrophic. In only 10 cases, before surgery, the inflammatory markers were positive. The isolated microorganisms were resistant to common antibiotics. In 70 out of 71 cases, plates and screws on the upper side and fibula allogenic splints at the bottom, associated with cancellous bone grafts taken from the patients' iliac crests, were implanted. In one case, however, it was decided to implant the plate on the front edge of the clavicle and the fibula allogeneic splint on the posterior margin, also associated with a cancellous bone graft taken from the patient's iliac crest. The radiographic bone healing was observed in 107.8 (range 82-160) days for the aseptic nonunions, while in 118.4 (range 82-203) days for the septic ones. The non-healing case was a serious failure that led to asubtotal excision of the clavicle. Conclusions. The importance of classification and study of nonunions are essential to achieve positive outcomes. The guiding principle of our work is that aseptic nonunions heal in the operating room, while infected nonunions can be challenged and defeated on the operating table. Restoring the correct length of the clavicle interconnection between the sternum and the shoulder cingulum is indispensable to avoid functional deficits of the upper limb. The fibula splint and the tricorticale bone graft have both mechanical and strong biological values to quickly heal the nonunion.The return to pre-injury quality of life has to be our main goal.

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Two-stage reimplantation for periprosthetic knee infection: Influence of host health status and infecting microorganism

Cited by 40 publications

References 39 publications

Treatment Failure Among Infected Periprosthetic Patients at a Highly Specialized Revision TKA Referral Practice

Treatment Failure Among Infected Periprosthetic Patients at a Highly Specialized Revision TKA Referral Practice

The use of spacers (static and mobile) in infection knee arthroplasty

The challenge of nonunion after osteosynthesis of the clavicle: is it a biomechanical or infection problem?

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