Can This Prosthesis Be Saved?: Implant Salvage Attempts in Infected Primary TKA

Abstract

Background Open débridement with polyethylene liner exchange (ODPE) remains a relatively low morbidity option in acute infection of total knee arthroplasty (TKA), but concerns regarding control of infection exist. We sought to identify factors that would predict control of infection after ODPE. Methods We identified 44 patients (44 knees) with culture-positive periprosthetic infection who underwent ODPE. Failure was defined as any reoperation performed for control of infection or the need for lifetime antibiotic suppression. Patients had been followed prospectively for a minimum of 1 year (mean, 5 years; range, 1-9 years). Results Twenty-five of the 44 patients (57%) failed ODPE. Of these 25 patients, two had one additional procedure, 21 had more than one additional procedure, and two required lifetime antibiotic suppression. Failure rates tended to differ based on primary organism: 71% of Staphylococcus aureus periprosthetic infection failed versus 29% of Staphylococcus epidermidis, although with the limited numbers theses differences were not significant. Age, gender, or measures of comorbidity did not influence the risk of failure. There was no difference in failure rate (58% versus 50%) when the ODPE was performed greater than 4 weeks after index TKA. After a failed ODPE, 19 of the 25 failures went on to an attempted two-stage revision procedure. In only 11 of these 19 cases was the two-stage revision ultimately successful.

Periprosthetic Joint Infection in Patients with Inflammatory Joint Disease: A Review of Risk Factors and Current Approaches to Diagnosis and Management

“…In certain clinical situations such as in early/acute infections, or when patients have major comorbidities making them poor operative candidates, retention of hardware can be selected. However, it has a lower rate of cure and patients usually require continued infection control and suppression via prolonged oral antibiotics [13].…”

Cathodic Electrical Stimulation Combined With Vancomycin Enhances Treatment of Methicillin-resistant Staphylococcus aureus Implant-associated Infections

“…The frequency of infection after primary hip and knee arthroplasty has been reduced to 0.3% to 2% with modern aseptic techniques, but this has reached 20% in some revision procedures [17,20]. Currently, the preferred treatment for periprosthetic joint infection is a two-staged revision arthroplasty with antibiotic spacer placement resulting from bacterial biofilm formation on the retained components [15,27,30]. Although effective, this method requires multiple surgical procedures, increases healthcare costs, limits mobility, and increases soft tissue and skeletal damage often resulting in additional reconstructive procedures at the time of replantation of permanent components [15,27].…”

Decreased bacteria activity on Si3N4 surfaces compared with PEEK or titanium

“…Mortality rates from complications related to deep prosthetic infections in THA and TKA are reportedly between 2.7% and 18%, 6 and infection is the most common reason for repeat surgery after otherwise successful prosthetic joint replacement. 7 The incidence of infection in THA and TKA may be increasing, probably due to improved detection and also because of evolving antibiotic-resistant bacteria strains. Treatment costs related to infected orthopedic implants can range from 1.52 to 1.76 times the cost of the original surgery.…”