Risk Factors for Repeat Debridement, Spacer Retention, Amputation, Arthrodesis, and Mortality After Removal of an Infected Total Knee Arthroplasty With Spacer Placement

Cancienne, Jourdan M.; Granadillo, Victor Anciano; Patel, Kishan; Werner, Brian C.; Browne, James A.

doi:10.1016/j.arth.2017.08.037

Cited by 41 publications

(21 citation statements)

References 41 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Long‐term systemic antibiotics are administered to eradicate infection in vascularized tissue and prevent the systemic dissemination of bacteria . Despite antibiotic administration, the failure rate of the gold standard is about 25%, which puts the patients at risk for more dire consequences such as arthrodesis or amputation …”

mentioning

confidence: 99%

Longitudinal Model of Periprosthetic Joint Infection in the Rat

Fan

Xiao

Sabuhi

et al. 2019

Journal Orthopaedic Research

View full text Add to dashboard Cite

The majority of periprosthetic joint infections occur shortly after primary joint replacement (<3 months) and require the removal of all implant components for the treatment period (~4 months). A clinically relevant animal model of periprosthetic infection should, therefore, establish an infection with implant components in place. Here, we describe a joint replacement model in the rat with ultrahigh molecular weight polyethylene (UHMWPE) and titanium components inoculated at the time of surgery by methicillin-sensitive Staphylococcus aureus (S. aureus), which is one of the main causative microorganisms of periprosthetic joint infections. We monitored the animals for 4 weeks by measuring gait, weight-bearing symmetry, von Frey testing, and micro-CT as our primary endpoint analyses. We also assessed the infection ex vivo using colony counts on the implant surfaces and histology of the surrounding tissues. The results confirmed the presence of a local infection for 4 weeks with osteolysis, loosening of the implants, and clinical infection indicators such as redness, swelling, and increased temperature. The utility of specific gait analysis parameters, especially temporal symmetry, hindlimb duty factor imbalance, and phase dispersion was identified in this model for assessing the longitudinal progression of the infection, and these metrics correlated with weight-bearing asymmetry. We propose to use this model to study the efficacy of using different local delivery regimens of antimicrobials on addressing periprosthetic joint infections. Statement of clinical significance: We have established a preclinical joint surgery model, in which postoperative recovery can be monitored over a multi-week course by assessing gait, weight-bearing, and allodynia. This model can be used to study the efficacy of different combinations of implant materials and medication regimens.

show abstract

mentioning

confidence: 99%

Longitudinal Model of Periprosthetic Joint Infection in the Rat

Fan

Xiao

Sabuhi

et al. 2019

Journal Orthopaedic Research

View full text Add to dashboard Cite

show abstract

“…Cancienne et al reviewed the outcomes of 18,533 patients 1 year after being treated for TKA PJI and 3.7% died in a hospital setting, 4.5% underwent knee arthrodesis, 3.1% underwent an amputation, 14.5% underwent a repeat debridement procedure without being reimplanted, 12.5% retained their spacer, and 61.6% underwent spacer removal and implantation. 22 Patients requiring microvascular-free flap coverage for salvage of the infected TKA are at particular risk of failure. 64 When faced with the nearly ⅓ of patients who are not eligible for reimplantation or who undergo reimplantation and get reinfected, there are several salvage options to consider.…”

Section: Salvage Proceduresmentioning

confidence: 99%

“…Cancienne et al evaluated the outcomes of 18,533 patients with a minimum of 1-year follow-up and found that 38.4% of patients do not undergo reimplantation at 1 year. 22 Although 61.6% of patients underwent spacer removal and reimplantation, 3.7% died in a hospital setting, 4.5% underwent knee arthrodesis, 3.1% underwent amputation, 14.5% underwent repeat debridement procedures without reimplantation, and 12.5% retained their spacers. 22 Although superficial infections can occur, it is imperative that surgeons do not deceive themselves into thinking something is superficial when it is deep.…”

Section: Treatment Of Infected Tkamentioning

confidence: 99%

“…22 Although 61.6% of patients underwent spacer removal and reimplantation, 3.7% died in a hospital setting, 4.5% underwent knee arthrodesis, 3.1% underwent amputation, 14.5% underwent repeat debridement procedures without reimplantation, and 12.5% retained their spacers. 22 Although superficial infections can occur, it is imperative that surgeons do not deceive themselves into thinking something is superficial when it is deep. When treated with irrigation and debridement alone, superficial infections have been shown to have a relatively high success rate of approximately 85% in contrast with a relatively low success rate of 69% observed in deep infections.…”

Section: Treatment Of Infected Tkamentioning

confidence: 99%

See 1 more Smart Citation

Current Insights in the Evaluation and Treatment of Infected Total Knee Arthroplasty

Ashley

Parvızı

2021

J Knee Surg

View full text Add to dashboard Cite

Total knee arthroplasty is a widely successful procedure, but a small percentage of patients have a postoperative course complicated by periprosthetic joint infection (PJI). PJI is a difficult problem to diagnose and to treat, and the management of PJI differs, depending on the acuity of the infection. This paper discusses the established and newer technologies developed for the diagnosis of PJI as well as different treatment considerations and surgical solutions currently available.

show abstract

“…Gram-positive cocci often cause early postoperative infection [6]. The widespread distribution of methicillinresistant staphylococcus strains (MRS infection) obstructs the curative therapy of periprosthetic infectious complications due to resistance to β-lactam antibiotics and other classes of antibacterial drugs.…”

Section: Introductionmentioning

confidence: 99%

Etiological role of opportunistic microflora in the pathogenesis of implant-associated inflammation after primary total knee replacement

et al. 2021

View full text Add to dashboard Cite

Objective: to investigate etiological role of opportunistic microflora in the pathogenesis of implant-associated inflammation in patients after primary knee replacement and antibiotic resistance of major infectious agent groups. Material and Methods. We conducted the retrospective analysis of microbiological samples from 383 patients with postoperative implant-associated inflammation after the primary total knee arthroplasty. Results. Gram-positive cocci (63.5%) are the leading agents of implant-associated inflammation. We also noted an increase in the etiological role of coagulase-positive staphylococci. Among the Gram-negative group, Enterobacteriaceae and non-fermenting bacteria were major agents. We revealed high resistance of Staphylococcus spp. to antibiotics of various groups, among which oxazolidinones and glycylcyclines were the most active. Gram-negative bacteria exhibited high resistance to cephalosporine and macrolides, whereas carbapenems and fluoroquinolones worked best. Conclusion. Gram-negative Enterobacteriaceae, non-fermenters, and Gram-positive cocci are the most significant etiological factors in the pathogenesis of implant-associated inflammation in patients after primary total knee arthroplasty.

show abstract

Risk Factors for Repeat Debridement, Spacer Retention, Amputation, Arthrodesis, and Mortality After Removal of an Infected Total Knee Arthroplasty With Spacer Placement

Cited by 41 publications

References 41 publications

Longitudinal Model of Periprosthetic Joint Infection in the Rat

Longitudinal Model of Periprosthetic Joint Infection in the Rat

Current Insights in the Evaluation and Treatment of Infected Total Knee Arthroplasty

Etiological role of opportunistic microflora in the pathogenesis of implant-associated inflammation after primary total knee replacement

Contact Info

Product

Resources

About