Skip to main content
SpringerLink
Log in

Microbiological Concepts of the Infected Total Knee Arthroplasty

  • Chapter
  • First Online:
The Infected Total Knee Arthroplasty

Abstract

The microbiology of the infected joint replacement is now well established. Causative organisms are generally gram positive, principally staphylococci and streptococci, but many organisms may cause periprosthetic joint infection (PJI), particularly in the presence of immunosuppression. Infections following total knee arthroplasty (TKA) are difficult to treat due to the formation of biofilms, which protect the causative bacteria from antibiotics and host defenses. Adequate prevention, diagnosis, and management schemes for biofilm-based PJIs are still lacking. The current approach to biofilms centers on prevention, with the use of local and systemic antibiotics. Future strategies for the prevention and treatment of biofilms include the use of surface coatings (including surface-tethered antibiotics and metal oxide nanoparticle coatings) and disruption of the established biofilm by mechanical or pharmacological means.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 119.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Nana A, Nelson SB, McLaren A, Chen AF. What’s new in musculoskeletal infection: update on biofilms. J Bone Joint Surg Am. 2016;98:1226–34.

    Article  PubMed  Google Scholar 

  2. Benito N, Franco M, Ribera A, Soriano A, Rodriguez-Pardo D, Sorli L, et al. Time trends in the aetiology of prosthetic joint infections: a multicentre cohort study. Clin Microbiol Infect. 2016;22(732):e731–8.

    Google Scholar 

  3. Nickinson RS, Board TN, Gambhir AK, Porter ML, Kay PR. The microbiology of the infected knee arthroplasty. Int Orthop. 2010;34:505–10.

    Article  CAS  PubMed  Google Scholar 

  4. Holleyman RJ, Deehan DJ, Charlett A, Gould K, Baker PN. Does pre-operative sampling predict intra-operative cultures and antibiotic sensitivities in knee replacements revised for infection?: a study using the NJR dataset. Knee Surg Sports Traumatol Arthrosc. 2016;24:3056–63.

    Article  PubMed  Google Scholar 

  5. Matthews PC, Berendt AR, McNally MA, Byren I. Diagnosis and management of prosthetic joint infection. BMJ. 2009;338:b1773.

    Article  PubMed  Google Scholar 

  6. Laudermilch DJ, Fedorka CJ, Heyl A, Rao N, McGough RL. Outcomes of revision total knee arthroplasty after methicillin-resistant Staphylococcus aureus infection. Clin Orthop Relat Res. 2010;468:2067–73.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Garvin KL, Hinrichs SH, Urban JA. Emerging antibiotic-resistant bacteria. Their treatment in total joint arthroplasty. Clin Orthop Relat Res. 1999;369:110–23.

    Article  Google Scholar 

  8. Jain R, Kralovic SM, Evans ME, Ambrose M, Simbartl LA, Obrosky DS, et al. Veterans Affairs initiative to prevent methicillin-resistant Staphylococcus aureus infections. N Engl J Med. 2011;364:1419–30.

    Article  CAS  PubMed  Google Scholar 

  9. Jarlier V, Trystram D, Brun-Buisson C, Fournier S, Carbonne A, Marty L, et al. Curbing methicillin-resistant Staphylococcus aureus in 38 French hospitals through a 15-year institutional control program. Arch Intern Med. 2010;170:552–9.

    Article  PubMed  Google Scholar 

  10. Heym B, Jouve F, Lemoal M, Veil-Picard A, Lortat-Jacob A, Nicolas-Chanoine MH. Pasteurella multocida infection of a total knee arthroplasty after a “dog lick”. Knee Surg Sports Traumatol Arthrosc. 2006;14:993–7.

    Article  CAS  PubMed  Google Scholar 

  11. Rispler DT, Stirton JW, Gilde AK, Kane KR. Mycobacterium bovid infection of total knee arthroplasty after bacille Calmette-Guerin therapy for bladder cancer. Am J Orthop (Belle Mead NJ). 2015;44:E46–8.

    Google Scholar 

  12. Klein R, Dababneh AS, Palraj BR. Streptococcus gordonii prosthetic joint infection in the setting of vigorous dental flossing. BMJ Case Rep. 2015. pii: bcr2015210695. https://doi.org/10.1136/bcr-2015-210695.

  13. Gomez E, Chiang T, Louie T, Ponnapalli M, Eng R, Huang DB. Prosthetic joint infection due to Mycobacterium bovis after intravesical instillation of Bacillus Calmette-Guerin (BCG). Int J Microbiol. 2009;2009:527208.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Liddle AD, Abram S, Iyer S, Andrade AJ. Streptococcus gallolyticus prosthetic joint infection associated with undiagnosed colonic malignancy. Knee Surg Sports Traumatol Arthrosc. 2012;20:1069–70.

    Article  PubMed  Google Scholar 

  15. Roerdink RL, Douw CM, Leenders AC, Dekker RS, Dietvorst M, Oosterbos CJ, et al. Bilateral periprosthetic joint infection with Ureaplasma urealyticum in an immunocompromised patient. Infection. 2016;44:807–10.

    Article  CAS  PubMed  Google Scholar 

  16. Kim SJ, Kim JH. Late onset Mycobacterium tuberculosis infection after total knee arthroplasty: a systematic review and pooled analysis. Scand J Infect Dis. 2013;45:907–14.

    Article  PubMed  Google Scholar 

  17. Jakobs O, Schoof B, Klatte TO, Schmidl S, Fensky F, Guenther D, et al. Fungal periprosthetic joint infection in total knee arthroplasty: a systematic review. Orthop Rev (Pavia). 2015;7:5623.

    Article  Google Scholar 

  18. Cobo F, Rodriguez-Granger J, Lopez EM, Jimenez G, Sampedro A, Aliaga-Martinez L, et al. Candida-induced prosthetic joint infection. A literature review including 72 cases and a case report. Infect Dis (Lond). 2017;49:81–94.

    Article  Google Scholar 

  19. Ueng SW, Hsieh PH, Shih HN, Chan YS, Lee MS, Chang Y. Antibacterial activity of joint fluid in cemented total-knee arthroplasty: an in vivo comparative study of polymethylmethacrylate with and without antibiotic loading. Antimicrob Agents Chemother. 2012;56:5541–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Hedstrom SA, Lidgren L, Nilsson-Ehle I. Cefuroxime in acute septic arthritis. Scand J Infect Dis. 1984;16:79–82.

    Article  CAS  PubMed  Google Scholar 

  21. Sanz-Ruiz P, Matas-Diez JA, Sanchez-Somolinos M, Villanueva-Martinez M, Vaquero-Martin J. Is the commercial antibiotic-loaded bone cement useful in prophylaxis and cost saving after knee and hip joint arthroplasty? The transatlantic paradox. J Arthroplast. 2017;32:1095–9.

    Article  Google Scholar 

  22. Masri BA, Duncan CP, Beauchamp CP. Long-term elution of antibiotics from bone-cement: an in vivo study using the prosthesis of antibiotic-loaded acrylic cement (PROSTALAC) system. J Arthroplast. 1998;13:331–8.

    Article  CAS  Google Scholar 

  23. Fink B, Vogt S, Reinsch M, Buchner H. Sufficient release of antibiotic by a spacer 6 weeks after implantation in two-stage revision of infected hip prostheses. Clin Orthop Relat Res. 2011;469:3141–7.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Whiteside LA, Roy ME, Nayfeh TA. Intra-articular infusion: a direct approach to treatment of infected total knee arthroplasty. Bone Joint J. 2016;98-B(1 Suppl A):31–6.

    Article  CAS  PubMed  Google Scholar 

  25. Costerton JW, Geesey GG, Cheng KJ. How bacteria stick. Sci Am. 1978;238:86–95.

    Article  CAS  PubMed  Google Scholar 

  26. Costerton JW, Stewart PS, Greenberg EP. Bacterial biofilms: a common cause of persistent infections. Science. 1999;284:1318–22.

    Article  CAS  PubMed  Google Scholar 

  27. Arnold WV, Shirtliff ME, Stoodley P. Bacterial biofilms and periprosthetic infections. J Bone Joint Surg Am. 2013;95:2223–9.

    PubMed  Google Scholar 

  28. Elias S, Banin E. Multi-species biofilms: living with friendly neighbors. FEMS Microbiol Rev. 2012;36:990–1004.

    Article  CAS  PubMed  Google Scholar 

  29. Flemming HC, Wingender J. The biofilm matrix. Nat Rev Microbiol. 2010;8:623–33.

    CAS  PubMed  Google Scholar 

  30. Suda AJ, Kommerell M, Geiss HK, Burckhardt I, Zimmermann S, Zeifang F, et al. Prosthetic infection: improvement of diagnostic procedures using 16S ribosomal deoxyribonucleic acid polymerase chain reaction. Int Orthop. 2013;37:2515–21.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Zegaer BH, Ioannidis A, Babis GC, Ioannidou V, Kossyvakis A, Bersimis S, et al. Detection of bacteria bearing resistant biofilm forms, by using the universal and specific PCR is still unhelpful in the diagnosis of periprosthetic joint infections. Front Med (Lausanne). 2014;1:30.

    Google Scholar 

  32. Trampuz A, Piper KE, Jacobson MJ, Hanssen AD, Unni KK, Osmon DR, et al. Sonication of removed hip and knee prostheses for diagnosis of infection. N Engl J Med. 2007;357:654–63.

    Article  CAS  PubMed  Google Scholar 

  33. Tzeng A, Tzeng TH, Vasdev S, Korth K, Healey T, Parvizi J, et al. Treating periprosthetic joint infections as biofilms: key diagnosis and management strategies. Diagn Microbiol Infect Dis. 2015;81:192–200.

    Article  CAS  PubMed  Google Scholar 

  34. McDowell A, Patrick S. Evaluation of nonculture methods for the detection of prosthetic hip biofilms. Clin Orthop Relat Res. 2005;437:74–82.

    Article  Google Scholar 

  35. Stoodley P, Nistico L, Johnson S, Lasko LA, Baratz M, Gahlot V, et al. Direct demonstration of viable Staphylococcus aureus biofilms in an infected total joint arthroplasty. A case report. J Bone Joint Surg Am. 2008;90:1751–8.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Tunney MM, Patrick S, Gorman SP, Nixon JR, Anderson N, Davis RI, et al. Improved detection of infection in hip replacements. A currently underestimated problem. J Bone Joint Surg Br. 1998;80:568–72.

    Article  CAS  PubMed  Google Scholar 

  37. Penalba Arias P, Furustrand Tafin U, Betrisey B, Vogt S, Trampuz A, Borens O. Activity of bone cement loaded with daptomycin alone or in combination with gentamicin or PEG600 against Staphylococcus epidermidis biofilms. Injury. 2015;46:249–53.

    Article  PubMed  Google Scholar 

  38. Mitik-Dineva N, Wang J, Mocanasu RC, Stoddart PR, Crawford RJ, Ivanova EP. Impact of nano-topography on bacterial attachment. Biotechnol J. 2008;3:536–44.

    Article  CAS  PubMed  Google Scholar 

  39. Banche G, Allizond V, Bracco P, Bistolfi A, Boffano M, Cimino A, et al. Interplay between surface properties of standard, vitamin E blended and oxidised ultra high molecular weight polyethylene used in total joint replacement and adhesion of Staphylococcus aureus and Escherichia coli. Bone Joint J. 2014;96-B:497–501.

    Article  CAS  PubMed  Google Scholar 

  40. Kyomoto M, Shobuike T, Moro T, Yamane S, Takatori Y, Tanaka S, et al. Prevention of bacterial adhesion and biofilm formation on a vitamin E-blended, cross-linked polyethylene surface with a poly(2-methacryloyloxyethyl phosphorylcholine) layer. Acta Biomater. 2015;24:24–34.

    Article  CAS  PubMed  Google Scholar 

  41. Williams DL, Vinciguerra J, Lerdahl JM, Bloebaum RD. Does vitamin E-blended UHMWPE prevent biofilm formation? Clin Orthop Relat Res. 2015;473:928–35.

    Article  PubMed  Google Scholar 

  42. Lass R, Giurea A, Kubista B, Hirschl AM, Graninger W, Presterl E, et al. Bacterial adherence to different components of total hip prosthesis in patients with prosthetic joint infection. Int Orthop. 2014;38:1597–602.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Getzlaf MA, Lewallen EA, Kremers HM, Jones DL, Bonin CA, Dudakovic A, et al. Multi-disciplinary antimicrobial strategies for improving orthopaedic implants to prevent prosthetic joint infections in hip and knee. J Orthop Res. 2015;34:177–86.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Cochis A, Azzimonti B, Della Valle C, De Giglio E, Bloise N, Visai L, et al. The effect of silver or gallium doped titanium against the multidrug resistant Acinetobacter baumannii. Biomaterials. 2016;80:80–95.

    Article  CAS  PubMed  Google Scholar 

  45. Harrasser N, Jussen S, Banke IJ, Kmeth R, von Eisenhart-Rothe R, Stritzker B, et al. Antibacterial efficacy of titanium-containing alloy with silver-nanoparticles enriched diamond-like carbon coatings. AMB Express. 2015;5:77.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Singh G, Hameister R, Feuerstein B, Awiszus F, Meyer H, Lohmann CH. Low-frequency sonication may alter surface topography of endoprosthetic components and damage articular cartilage without eradicating biofilms completely. J Biomed Mater Res B Appl Biomater. 2014;102:1835–46.

    Article  PubMed  Google Scholar 

  47. Urish KL, DeMuth PW, Craft DW, Haider H, Davis CM III. Pulse lavage is inadequate at removal of biofilm from the surface of total knee arthroplasty materials. J Arthroplast. 2014;29:1128–32.

    Article  Google Scholar 

  48. Mihailescu R, Furustrand Tafin U, Corvec S, Oliva A, Betrisey B, Borens O, et al. High activity of Fosfomycin and Rifampin against methicillin-resistant Staphylococcus aureus biofilm in vitro and in an experimental foreign-body infection model. Antimicrob Agents Chemother. 2014;58:2547–53.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Viganor L, Galdino AC, Nunes AP, Santos KR, Branquinha MH, Devereux M, et al. Anti-Pseudomonas aeruginosa activity of 1,10-phenanthroline-based drugs against both planktonic- and biofilm-growing cells. J Antimicrob Chemother. 2016;71:128–34.

    Article  CAS  PubMed  Google Scholar 

  50. McConoughey SJ, Howlin R, Granger JF, Manring MM, Calhoun JH, Shirtliff M, et al. Biofilms in periprosthetic orthopedic infections. Future Microbiol. 2014;9:987–1007.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, “La Paz” University Hospital-IdiPaz, Paseo de la Castellana 261, 28046, Madrid, Spain

    E. Carlos Rodríguez-Merchán

  2. University College London Institute of Orthopaedics and Musculoskeletal Science, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK

    Alexander D. Liddle

Authors
  1. E. Carlos Rodríguez-Merchán
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alexander D. Liddle
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to E. Carlos Rodríguez-Merchán .

Editor information

Editors and Affiliations

  1. Department of Orthopaedic Surgery, La Paz University Hospital, Madrid, Spain

    E. Carlos Rodríguez-Merchán

  2. University College London Hospitals , London, United Kingdom

    Sam Oussedik

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG

About this chapter

Cite this chapter

Rodríguez-Merchán, E.C., Liddle, A.D. (2018). Microbiological Concepts of the Infected Total Knee Arthroplasty. In: Rodríguez-Merchán, E., Oussedik, S. (eds) The Infected Total Knee Arthroplasty. Springer, Cham. https://doi.org/10.1007/978-3-319-66730-0_2

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-66730-0_2

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-66729-4

  • Online ISBN: 978-3-319-66730-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation