Acute Hematogenous Infection Following Total Hip and Knee Arthroplasty

Konigsberg, Beau S.; Valle, Craig J. Della; Ting, Nicholas T.; Qiu, Fang; Sporer, Scott M.

doi:10.1016/j.arth.2013.07.021

Cited by 69 publications

(64 citation statements)

References 39 publications

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“…Zurcher-Pfund et al [59] found that 33% of patients treated with débridement and retention of their implants survived without reinfection if the patients had antibiotic-sensitive bacteria, but that no patient who had either MRSA or MRSE was treated successfully. A similar study [30] reported that 96% of patients treated with débridement and implant retention had successful treatment and avoided reinfection, but that only 45% were successfully treated if the infecting organism was staphylococcus. Reports of revision of cementless THA with late-onset acute infection are scarce in the literature.…”

Section: Discussionmentioning

confidence: 92%

One-stage Revision With Catheter Infusion of Intraarticular Antibiotics Successfully Treats Infected THA

Whiteside

Roy

2017

Clinical Orthopaedics &Amp; Related Research

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Background Two-stage revision surgery for infected total hip arthroplasty (THA) is commonly advocated, but substantial morbidity and expense are associated with this technique. In certain cases of infected THA, treatment with one-stage revision surgery and intraarticular infusion of antibiotics may offer a reasonable alternative with the distinct advantage of providing a means of delivering the drug in high concentrations. Questions/purposes We describe a protocol for intraarticular delivery of antibiotics to the hip through an indwelling catheter combined with one-stage revision surgery and examine (1) the success as judged by eradication of infection at 1 year when treating chronically infected cemented stems; (2) success in treating late-onset acute infections in well-ingrown cementless stems; and (3) what complications were associated with this approach in a small case series. Methods Between

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Section: Discussionmentioning

confidence: 92%

One-stage Revision With Catheter Infusion of Intraarticular Antibiotics Successfully Treats Infected THA

Whiteside

Roy

2017

Clinical Orthopaedics &Amp; Related Research

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“…It seems ODPLE is not effective in most cases of acute infection after TKA. Therefore, in these cases, a two-stage revision arthroplasty must be indicated [1][2][3][4][5][6][7][8][9][10][11][12][13] .…”

Section: Resultsmentioning

confidence: 99%

“…NA: Not available. Author Chin and Chen [6] Kim et al [8] Konigsberg et al [9] Koh et al [13] Mean Success Rate 50% 85% 75% 55%…”

Section: Clinical Efficacymentioning

confidence: 99%

“…The treatment for acute prosthetic knee infection is currently under debate [1][2][3][4] . Early open débridement with polyethylene liner exchange (ODPLE) is an attractive, but often ineffective strategy for the treatment of a TKA with acute infection [1][2][3][4][5][6][7][8][9][10][11][12][13] . The purpose of this article is to review the literature on acute infection after TKA with the aim of answering the following four questions: (1) Is ODPLE really effective?…”

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confidence: 99%

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Acute Infection in Total Knee Arthroplasty (TKA): Is Early Open D閎ridement with Polyethylene Liner Exchange (ODPLE) Really Effective?Tendon Healing: Biological Principles And Augmentation with Autogenous Mesenchymal Stem Cells, Current Concepts

Rodríguez-Merchán¹

2015

International Journal of Orthopaedics

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viable treatment option for acute prosthetic joint infection following TKA. The promptness of ODPLE is of paramount importance for success of the procedure. In Staphylococcus aureus infections the mean success rate is 7%, while in Streptococcal or Staphylococcus epidermidis species the mean success rate is 47%. The success rate of two-stage revision for infection is diminished after a failed ODPLE (66% mean success rate). It seems that acute infections after TKA in the presence of Staphylococcus aureus must be treated by a two-stage revision arthroplasty. Key words: INTRODUCTIONWhile infection in total knee arthroplasty (TKA) is a relatively infrequent complication, it can be devastating in terms of morbidity and cost. The risk of infection ranges from 0.5% to 2% for primary TKAs. The treatment for acute prosthetic knee infection is currently under debate [1][2][3][4] . Early open débridement with polyethylene liner exchange (ODPLE) is an attractive, but often ineffective strategy for the treatment of a TKA with acute infection [1][2][3][4][5][6][7][8][9][10][11][12][13] . The purpose of this article is to review the literature on acute infection after TKA with the aim of answering the following four questions: (1) Is ODPLE really effective? (2) What is the success rate of early ODPLE? (3) Which factors can predict control of infection after early ODPLE; (4) Is the success rate of two-stage revision for infection diminished after a failed early ODPLE? ABSTRACTBackground: Open débridement with polyethylene liner exchange (ODPLE) is an attractive strategy for the treatment of a total knee arthroplasty (TKA) with acute infection. Purpose: The purpose of this article is to review the literature on acute infection after TKA with the aim of answering the following four questions: (1) Is ODPLE really effective? (2) What is the success rate of ODPLE? (3) Which factors can predict control of TKA acute infection after early ODPLE? (4) Is the success rate of two-stage revision for infection diminished after a failed early ODPLE? Methods: The search engines were MedLine, EMBASE and the Cochrane Library. The keywords used were: acute TKA infection. Fifty-three articles were found until 20 October 2015. Of those, only thirteen were selected and reviewed because they were strictly focused on the topic and the questions of this article. Results: Although the level of evidence of published papers is low, the mean success rate in postoperative acute infections ranged between 35% and 95%, and between 50% and 85% 70% in acute hematogenous infections. The only factor that can predict control of infection after ODPLE is the type of infected organism (Staphylococcus aureus 7% success rate, Staphylococcus epidermidis and Streptococcus species 47% success rate). The success rate of two-stage revision is diminished after a failed ODPLE (66% success rate). Conclusions: ODPLE should be considered as a REVIEW

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“…Unfortunately, to date, no comparative studies between different strategies are available and therefore no hard recommendations regarding which one to use can be made. For every strategy different studies are published with results ranging from poor to excellent (21% to 90% success rate) [49,[52][53][54] . All of them are retrospective case-series, which are often quite heterogeneous regarding inclusion, exact treatment and outcomes.…”

Section: Risk Factors For (Acute) Pjimentioning

confidence: 99%

Treatment of acute periprosthetic infections with prosthesis retention: Review of current concepts

Kuiper

Willink

Moojen

et al. 2014

WJO

109

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Periprosthetic joint infection (PJI) is a devastating complication after total joint arthroplasty, occurring in approximately 1%-2% of all cases. With growing populations and increasing age, PJI will have a growing effect on health care costs. Many risk factors have been identified that increase the risk of developing PJI, including obesity, immune system deficiencies, malignancy, previous surgery of the same joint and longer operating time. Acute PJI occurs either postoperatively (4 wk to 3 mo after initial arthroplasty, depending on the classification system), or via hematogenous spreading after a period in which the prosthesis had functioned properly. Diagnosis and the choice of treatment are the cornerstones to success. Although different definitions for PJI have been used in the past, most are more or less similar and include the presence of a sinus tract, blood infection values, synovial white blood cell count, signs of infection on histopathological analysis and one or more positive culture results. Debridement, antibiotics and implant retention (DAIR) is the primary treatment for acute PJI, and should be performed as soon as possible after the development of symptoms. Success rates differ, but most studies report success rates of around 60%-80%. Whether single or multiple debridement procedures are more successful remains unclear. The use of local antibiotics in addition to the administration of systemic antibiotic agents is also subject to debate, and its pro's and con's should be carefully considered. Systemic treatment, based on culture results, is of importance for all PJI treatments. Additionally, rifampin should be given in Staphylococcal PJIs, unless all foreign material is removed. The most important factors contributing to treatment failure are longer duration of symptoms, a longer time after initial arthroplasty, the need for more debridement procedures, the retention of exchangeable components, and PJI caused by Staphylococcus (aureus or coagulase negative). If DAIR treatment is unsuccessful, the following treatment option should be based on the patient health status and his or her expectations. For the best functional outcome, one-or two-stage revision should be performed after DAIR failure. In conclusion, DAIR is the obvious choice for treatment of acute PJI, with good success rates in selected patients. Key words: Arthroplasty; Prosthesis; Infection; Periprosthetic joint infection; Retention; Debridement antibiotics and implant retention; Debridement; Acute Core tip: Acute periprosthetic joint infection (PJI) is a major complication after total joint arthroplasty, and occurs either postoperatively or via hematogenous spreading. Debridement, antibiotics and implant retention (DAIR), the primary treatment for acute PJI, should be performed as soon as possible after the development of symptoms, and has success rates around 60%-80%. Whether single or multiple debridement procedures are more successful remains unclear. Sys- REVIEW

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Acute Hematogenous Infection Following Total Hip and Knee Arthroplasty

Cited by 69 publications

References 39 publications

One-stage Revision With Catheter Infusion of Intraarticular Antibiotics Successfully Treats Infected THA

One-stage Revision With Catheter Infusion of Intraarticular Antibiotics Successfully Treats Infected THA

Acute Infection in Total Knee Arthroplasty (TKA): Is Early Open D閎ridement with Polyethylene Liner Exchange (ODPLE) Really Effective?Tendon Healing: Biological Principles And Augmentation with Autogenous Mesenchymal Stem Cells, Current Concepts

Treatment of acute periprosthetic infections with prosthesis retention: Review of current concepts

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