Implant Salvage in Infected Total Knee Arthroplasty

Burger, Robert R.; Basch, Thomas; Hopson, Clark N.

doi:10.1097/00003086-199112000-00015

Cited by 125 publications

(83 citation statements)

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“…Schoifet and Morrey reported 31 infected TKAs and noted the duration of symptoms averaged 15 days longer in those patients who failed ODPE [16]. In a retrospective review of 39 infected TKAs, Burger et al reported a success rate of only 17.9% after irrigation and débridement [3]. The average duration of symptoms for the failed knees was 117 days versus [14].…”

Section: Gram-negativesmentioning

confidence: 99%

“…An understandable selection bias occurs as the result of surgeons attempting ODPE only in cases in which the PPI is believed to be acute. Given the poor results with ODPE in treating chronic infections [3,17], most surgeons in our series undoubtedly used two-stage reimplantation when managing a patient with prolonged symptoms. Multiple studies have also described a correlation between the duration of time from the index primary TKA surgery to ODPE.…”

Section: Gram-negativesmentioning

confidence: 99%

“…One study suggests lower morbidity and retention of well-fixed primary components are reasons for choosing ODPE [13]. Infection eradication with ODPE, however, has generally not approached the success rate associated with formal two-stage reimplantation [3,8,9]. Control of infection with ODPE is traditionally linked to various factors, including host comorbidities, virulence of the infecting organism, and timing of the infection in relation to the original surgery [10,19].…”

Section: Introductionmentioning

confidence: 99%

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

Gardner

Gioe

Tatman

2011

Clinical Orthopaedics &Amp; Related Research

141

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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.

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Section: Gram-negativesmentioning

confidence: 99%

Section: Gram-negativesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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

Gardner

Gioe

Tatman

2011

Clinical Orthopaedics &Amp; Related Research

141

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“…Various methods have been used in the initial treatment of periprosthetic knee infection, including irrigation and debridement [10,11,38], direct exchange arthroplasty [6,16], and two-stage revision TKA with subsequent reimplantation [15,18]. Incision and drainage has been an attractive option, with low cost and relatively low morbidity; however, the failure rate has been high, ranging between 61% and 82% [4,5,7,23,30,35,38,39,41,44]. There has also been evidence suggesting that patients who failed a previous incision and drainage procedure were more likely to have a higher rate of failure with a subsequent two-stage revision arthroplasty [46].…”

Section: Introductionmentioning

confidence: 99%

Assessing the Gold Standard: A Review of 253 Two-Stage Revisions for Infected TKA

Mahmud

Lyons

Naudie

et al. 2012

Clinical Orthopaedics &Amp; Related Research

124

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Background Periprosthetic joint infection has been the leading cause of failure following TKA surgery. The gold standard for infection control has been a two-staged revision TKA. There have been few reports on mid-to longterm survivorship, functional outcomes, and fate of patients with a failed two-stage revision TKA. Questions/purposes Therefore, we determined (1) the mid-term survivorship of two-stage revision TKA, (2) the function of patients in whom infection was controlled, and (3) the outcome of patients with a failed two-stage revision due to recurrent infection. Methods We retrospectively reviewed 239 patients who underwent 253 two-stage revision TKAs for periprosthetic infection. There were 239 patients (253 knees), 104 men and 135 women, with a mean age of 70 ± 10 years at the time of two-stage revision and a mean BMI of 31.53 ± 6.74 kg/m 2 . During followup, we obtained WOMAC and The Knee Society Clinical Rating Scores and radiographs.

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“…The duration of symptoms is important, since several studies have shown a high success rate (82-100%) with debridement and retention, if the duration is 3 weeks (Burger et al 1991, Widmer et al 1992, Zimmerli et al 1998, Tattevin et al 1999, Meehan et al 2003, Barberan 2006, Laffer et al 2006. The time to diagnosis of infection, described by Choong et al (2007) ranged from 5 to 105 days.…”

mentioning

confidence: 99%