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Erschienen in:
01.08.2010 | Symposium: Papers Presented at the 2009 Meeting of the Musculoskeletal Infection Society
Two-stage Exchange Knee Arthroplasty: Does Resistance of the Infecting Organism Influence the Outcome?
Erschienen in: Clinical Orthopaedics and Related Research® | Ausgabe 8/2010
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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, 24–90.1 months). Cases were defined as failures of two-stage exchange arthroplasty.
Results
Two-stage exchange arthroplasty was successful in controlling the infection in 70 patients (73%). Patients who failed two-stage exchange arthroplasty were 3.37 times more likely to have been originally infected with a methicillin-resistant organism. Older age, higher body mass index, and history of thyroid disease were predisposing factors to infection with a methicillin-resistant organism.
Conclusions
Innovative interventions are needed to improve the effectiveness of two-stage exchange arthroplasty for TKA infection with a methicillin-resistant organism as current treatment protocols may not be adequate for control of these virulent pathogens.
Level of Evidence
Level IV, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.