Two-Year Outcome of Early Deep MRSA Infections After Primary Total Knee Arthroplasty

Siddiqui, M Mashfiqul A.; Lo, Ngai Nung; Rahman, Shaifuzain Ab; Chin, Pak Lin; Chia, Shi‐Lu; Yeo, Seng Jin

doi:10.1016/j.arth.2012.04.007

Cited by 31 publications

(31 citation statements)

References 25 publications

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“…Our long-term follow-up data and literature review suggest that debridement and retention of knee PJIs may be inefficient for MRSA infections [3,15], moderately successful for methicillin-sensitive S. aureus infections [7,9,14,23], but a valid option for streptococcal PJIs [8,16]. The odds for succeeding with implant retention for streptococcal PJIs compared to staphylococcal infections (methicillin-susceptible S. aureus and coagulase-negative staphylococci included) were fivefold.…”

Section: Discussionmentioning

confidence: 87%

“…Other, yet unexplored physiopathological mechanisms are most probably involved in this respect. As a conclusion, based upon our findings, we believe that the identified pathogen (and not merely its methicillin resistance [1,3,5,15]) should influence the decision for prosthesis retention in knee PJIs, besides consideration of the patient's general condition, sinus tracts, implant loosening or chronicity of the infection. We thus disregard retention in cases of knee PJI for all staphylococcal disease and feel relatively comfortable in cases of streptococcal disease.…”

Section: Discussionmentioning

confidence: 99%

“…Only small case series with short-term follow-ups may yield remissions of 100 % [8], and interestingly papers in medical journals [7,[9][10][11][12] show higher success rates than those published is surgical journals [3,5,[13][14][15]. Many of these papers have substantial shortcomings.…”

Section: Introductionmentioning

confidence: 99%

“…With a few microbiological exceptions such as mycobacteria, fungi or possibly staphylococcal methicillin resistance [3,15,20,21], the surgeon's approach to the management of PJIs is very often pathogen independent [1]. According to existing literature and experts' recommendations, neither the duration of concomitant antibiotic prescription nor the choice of the surgical approach rely on species identification [1].…”

Section: Introductionmentioning

confidence: 99%

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Pathogen-driven decision for implant retention in the management of infected total knee prostheses

Zürcher-Pfund

Uçkay

Legout

et al. 2013

International Orthopaedics (SICOT)

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Purpose In prosthetic joint infections (PJIs) of the knee, debridement with implant retention is associated with a high risk of recurrence. Methods A single-centre cohort study was performed with extensive analysis of the literature covering 1980-2012. Results In 21 patients (mean age 80.4 years, 19 immunosuppressed), in association with 1.5-three months of antibiotic treatment, an attempt was made to salvage the prosthesis by open (11 patients) or arthroscopic (ten patients) debridement. After a mean follow-up of seven years (range four-20 years), patients were in remission in seven cases (33 %). Remission was achieved in 0 % of all methicillin-resistant Staphylococcus aureus (MRSA) infections (zero/three), in 0 % (zero/three) of methicillin-resistant coagulase-negative staphylococcal infections, in 29 % (two/seven) of methicillin-sensitive S. aureus infections and in 75 % (three/four) of infections due to streptococci. The literature review focused on implant preserving approaches yielded 599 cases with an overall success rate of 47 % (284/599) and significantly more remissions in streptococcal vs staphylococcal knee PJIs (43/54 vs 144/324; p< 0.01, odds ratio 4.9, 95 % confidence interval 2.4-10.9).Conclusions In addition to established indications for explantation such as implant loosening, sinus tract or methicillin resistance, the decision for debridement and retention of knee PJIs should also depend on the pathogen. Implant preservation is futile with methicillin-resistant staphylococci, but seems to be a valid option for streptococcal PJIs.

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Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Pathogen-driven decision for implant retention in the management of infected total knee prostheses

Zürcher-Pfund

Uçkay

Legout

et al. 2013

International Orthopaedics (SICOT)

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“…As a result, of studies with consistent evidence in the literature [6,11]. We have found only 3 38 comparative studies between DPRA and 2SR [12][13][14]. 39 The main purpose of this study was to compare the effectiveness to control 40 periprosthetic knee infection within 3 months to index arthroplasty between 2SR and 41 DPRA.…”

Section: Accepted Manuscriptmentioning

confidence: 93%

Debridement with prosthesis retention and antibiotherapy vs. two-stage revision for periprosthetic knee infection within 3 months after arthroplasty: a case–control study

Lizaur-Utrilla

González-Parreño

Gil-Guillén

et al. 2015

Clinical Microbiology and Infection

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Sixty-four patients with periprosthetic infection within 3 months of index arthroplasty, of whom 39 underwent debridement with prosthesis retention and antibiotherapy (DPRA), and 25 underwent two-stage revision (2SR), were compared regarding control of infection and functional outcomes by use of Knee Society scores. Failure was defined as the need for subsequent surgery to control infection. The failure rate after DPRA was 61.5%, and that after 2SR was 12.0% (p 0.001). The failure risk was not significantly associated with the duration of symptoms (≤4 weeks). The only predictor of failure was isolation of Staphylococcus aureus or Staphylococcus epidermidis. Treatment with 2SR required fewer surgical operations, a shorter duration of hospitalization, and a shorter duration of treatment. All patients who required a second debridement ultimately underwent prosthesis removal. The functional outcome was significantly better for 2SR at the last follow-up.

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Revision Knee Arthroplasty in the Infectious Setting

Bernasek,

Lyons,

Palumbo

et al. 2024

Trauma and Infection Control in Revision Hip and Knee Arthroplasty

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Two-Year Outcome of Early Deep MRSA Infections After Primary Total Knee Arthroplasty

Cited by 31 publications

References 25 publications

Pathogen-driven decision for implant retention in the management of infected total knee prostheses

Pathogen-driven decision for implant retention in the management of infected total knee prostheses

Debridement with prosthesis retention and antibiotherapy vs. two-stage revision for periprosthetic knee infection within 3 months after arthroplasty: a case–control study

Revision Knee Arthroplasty in the Infectious Setting

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