Infection after total knee arthroplasty

Blom, Ashley W; Brown, James; Taylor, Adrian; Pattison, Giles; Whitehouse, Sarah L.; Bannister, G.C.

doi:10.1302/0301-620x.86b5.14887

Cited by 311 publications

(179 citation statements)

References 17 publications

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“…We found the MRSA colonization rate in an elective spine surgery population was 2.8%. This rate is comparable to that reported in the orthopaedic arthroplasty literature, which ranges from 0.5% to 4% [1,10,12]. With the increasing prevalence of MRSA, this number can be expected to rise with time.…”

Section: Discussionsupporting

confidence: 80%

What Is the Prevalence of MRSA Colonization in Elective Spine Cases?

Chen

Chivukula

Jacobs

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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Background The incidence of methicillin-resistant Staphylococcus aureus (MRSA) infection is increasing. However, the prevalence of MRSA colonization among patients undergoing spine surgery is unclear. Questions/purposes We therefore (1) determined the prevalence of MRSA colonization in a population of patients scheduled for elective spine surgery; and (2) evaluated whether MRSA screening and treatment reduce the rate of early wound complications. Methods We retrospectively reviewed prospectively collected data from 1002 patients undergoing elective spine surgery in 2010. There were 719 primary and 283 revision surgeries. Instrumentation was used in 72.0% cases and autologous iliac crest bone graft was taken in 65.1%. Twelve patients were lost to followup; of the remaining 990 patients, 503 were screened for MRSA and 487 were not. MRSA-colonized patients were treated with mupirocin and chlorhexidine. An early wound complication was defined as wound drainage or the presence of an abscess. Patients were followed for a minimum of 3 months (average, 7 months; range, 3-545 days). Results Of the patients undergoing elective spine surgery and screened for MRSA, 14 of 503 (2.8%) were colonized with MRSA. The rates of early wound complications were similar for patients who were screened and pretreated for MRSA (17 of 503 [3.4%]) compared with those who were not (17 of 487 [3.5%]). Conclusions The colonization rate for MRSA in our elective spine surgery population was comparable to that in the arthroplasty literature.

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Section: Discussionsupporting

confidence: 80%

What Is the Prevalence of MRSA Colonization in Elective Spine Cases?

Chen

Chivukula

Jacobs

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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“…We analysed the haematological, immunological and molecular biomarker profiles of patients undergoing total knee arthroplasty [32], which offered a clinical model for studying PTI. Previous reports were either multi-centre studies of patients following diverse incidents of trauma [11] or studies using alternative blood collection procedures [26][27][28][33][34][35].…”

Section: Discussionmentioning

confidence: 99%

Post-traumatic immunosuppression is reversed by anti-coagulated salvaged blood transfusion: deductions from studying immune status after knee arthroplasty

Islam

Whitehouse

Mehendale

et al. 2014

Clinical and Experimental Immunology

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SummaryMajor trauma increases vulnerability to systemic infections due to poorly defined immunosuppressive mechanisms. It confers no evolutionary advantage. Our objective was to develop better biomarkers of post-traumatic immunosuppression (PTI) and to extend our observation that PTI was reversed by anti-coagulated salvaged blood transfusion, in the knowledge that others have shown that non-anti-coagulated (fibrinolysed) salvaged blood was immunosuppressive. A prospective non-randomized cohort study of patients undergoing primary total knee arthroplasty included 25 who received salvaged blood transfusions collected post-operatively into acid-citrate-dextrose anti-coagulant (ASBT cohort), and 18 non-transfused patients (NSBT cohort). Biomarkers of sterile trauma included haematological values, damage-associated molecular patterns (DAMPs), cytokines and chemokines. Salvaged blood was analysed within 1 and 6 h after commencing collection. Biomarkers were expressed as fold-changes over preoperative values. Certain biomarkers of sterile trauma were common to all 43 patients, including supranormal levels of: interleukin (IL)-6, IL-1-receptor-antagonist, IL-8, heat shock protein-70 and calgranulin-S100-A8/9. Other proinflammatory biomarkers which were subnormal in NSBT became supranormal in ASBT patients, including IL-1β, IL-2, IL-17A, interferon (IFN)-γ, tumour necrosis factor (TNF)-α and annexin-A2. Furthermore, ASBT exhibited subnormal levels of anti-inflammatory biomarkers: IL-4, IL-5, IL-10 and IL-13. Salvaged blood analyses revealed sustained high levels of IL-9, IL-10 and certain DAMPs, including calgranulin-S100-A8/9, alpha-defensin and heat shock proteins 27, 60 and 70. Active synthesis during salvaged blood collection yielded increasingly elevated levels of annexin-A2, IL-1β, Il-1-receptor-antagonist, IL-2, IL-4, IL-6, IL-8, IL-10, IL-12p70, IL-17A, IFN-γ, TNF-α, transforming growth factor (TGF)-β1, monocyte chemotactic protein-1 and macrophage inflammatory protein-1α. Elevated levels of high-mobility group-box protein-1 decreased. In conclusion, we demonstrated that anti-coagulated salvaged blood reversed PTI, and was attributed to immune stimulants generated during salvaged blood collection.

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“…Periprosthetic infection (PPI) occurs in 1% to 2% of primary TKAs and 3% to 5% of revision TKAs [3] and remains a devastating and challenging problem for both patient and surgeon [2,14,21,30]. Two-stage exchange arthroplasty with use of an interim antibiotic cement spacer is the accepted treatment in most circumstances with infection control rates ranging from 74.5% to 100% [23].…”

Section: Introductionmentioning

confidence: 99%

Is There a Preferred Articulating Spacer Technique for Infected Knee Arthroplasty?: A Preliminary Study

Kalore

Maheshwari

Sharma

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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Background Periprosthetic infection in TKA is a devastating and challenging problem for both patients and surgeons. Two-stage exchange arthroplasty with an interval antibiotic spacer reportedly has the highest infection control rate. Studies comparing static spacers with articulating spacers have reported varying ROM after reimplant, which could be due to differences in articulating spacer technique. Questions/purposes We therefore determined whether one of three articulating spacer techniques was superior in terms of (1)

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Infection after total knee arthroplasty

Cited by 311 publications

References 17 publications

What Is the Prevalence of MRSA Colonization in Elective Spine Cases?

What Is the Prevalence of MRSA Colonization in Elective Spine Cases?

Post-traumatic immunosuppression is reversed by anti-coagulated salvaged blood transfusion: deductions from studying immune status after knee arthroplasty

Is There a Preferred Articulating Spacer Technique for Infected Knee Arthroplasty?: A Preliminary Study

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