Two-stage revision arthroplasty for coagulase-negative staphylococcal periprosthetic joint infection of the hip and knee

Abstract

BACKGROUNDPeriprosthetic joint infections (PJIs) are frequently caused by coagulase-negative Staphylococci (CoNS), which is known to be a hard-to-treat microorganism. Antibiotic resistance among causative pathogens of PJI is increasing. Two-stage revision is the favoured treatment for chronic CoNS infection of a hip or knee prosthesis. We hypothesised that the infection eradication rate of our treatment protocol for two-stage revision surgery for CoNS PJI of the hip and knee would be comparable to eradication rates described in the literature.AIMTo evaluate the infection eradication rate of two-stage revision arthroplasty for PJI caused by CoNS.METHODSAll patients treated with two-stage revision of a hip or knee prosthesis were retrospectively included. Patients with CoNS infection were included in the study, including polymicrobial cases. Primary outcome was infection eradication at final follow-up.RESULTSForty-four patients were included in the study. Twenty-nine patients were treated for PJI of the hip and fifteen for PJI of the knee. At final follow-up after a mean of 37 mo, recurrent or persistent infection was present in eleven patients.CONCLUSIONPJI with CoNS can be a difficult to treat infection due to increasing antibiotic resistance. Infection eradication rate of 70%-80% may be achieved.

High Risk for Persistent Peri-Prosthetic Infection and Amputation in Mega-Prosthesis Reconstruction

“…One of the most feared complications is peri-prosthetic infection, often resulting in repeated surgery, prolonged antibiotic treatment, and sometimes even in an amputation of the affected limb. Coagulase-negative staphylococci has been reported to be the most common bacteria, and may be difficult to treat due to a combination of extensive antimicrobial resistance, biofilm forming propensity, and delayed diagnosis [6].…”