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Prosthetic knee infection by resistant bacteria: the worst-case scenario

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The aim of the present paper was to determine (1) the incidence of failure (defined as the persistence or the recurrence of the infection), (2) the incidence of prosthesis (or even limb) loss (defined as the final need for an arthrodesis, resection arthroplasty or amputation) and (3) what factors could influence the failure in patients treated with a two-stage reimplantation for periprosthetic knee infections caused by resistant bacteria.

Methods

The authors retrospectively reviewed 29 total knee arthroplasties infected by resistant bacteria in 29 patients who underwent a two-stage revision. Between the stages, intravenous-targeted antibiotics were administered for a median period of 8 (range 6–12) weeks. Median follow-up was 10 (range 7–14) years.

Results

The authors found that failure occurred in 5 of 29 patients (17.2 %). When methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-resistant coagulase-negative staphylococci (MR-CoNS) were involved, failure rate was 10 % (2 of 20). When vancomycin-resistant enterococcus (VRE), multidrug-resistant (MDR) Acinetobacter baumannii and MDR Pseudomonas aeruginosa were involved, the failure rate was 33.3 % (3 of 9). Of those five patients, two underwent amputations, one chronic suppressive antibiotic therapy, one arthrodesis and one resection arthroplasty; among them, three lost the limb (10.3 % of the overall group). Timing of reimplantation and patient comorbidities did not significantly influence the failure.

Conclusions

Two-stage protocol resulted in a viable option for patients with infections by some resistant organisms (MRSA and MR-CoNS). However, when highly resistant organisms were involved (VRE, MDR Acinetobacter Baumannii and MDR Pseudomonas aeruginosa), the failure rate was much higher. In all cases of failure of the two-stage reimplantation, prosthesis (or even limb) loss occurred. Consequently, patients should be counselled that when highly resistant bacteria are involved, two-stage reimplantation could not be successful, with high final risk of prosthesis (or even limb) loss.

Level of evidence

Retrospective case series, Level IV.

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Acknowledgments

The authors thank Dr. Marco De Gori for his help with the statistical analysis.

Author information

Authors and Affiliations

  1. Department of Medicine and Health Sciences, University of Molise, Via Francesco De Sanctis, 86100, Campobasso, Italy

    Michele Vasso & Alfredo Schiavone Panni

  2. Adult Reconstruction and Joint Replacement Division, Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA

    Ivan De Martino

  3. Department of Orthopaedic and Trauma Surgery, Magna Graecia University, Mater Domini University Hospital, Viale Europa, 88100, Catanzaro, Italy

    Giorgio Gasparini

Authors
  1. Michele Vasso
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  2. Alfredo Schiavone Panni
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  3. Ivan De Martino
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  4. Giorgio Gasparini
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Corresponding author

Correspondence to Michele Vasso.

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The authors declare that they have no conflict of interest.

Additional information

This work was performed at the Department of Geriatrics, Neurosciences, and Orthopedics, Agostino Gemelli University Hospital, Catholic University of the Sacred Heart, Rome, Italy.

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Vasso, M., Schiavone Panni, A., De Martino, I. et al. Prosthetic knee infection by resistant bacteria: the worst-case scenario. Knee Surg Sports Traumatol Arthrosc 24, 3140–3146 (2016). https://doi.org/10.1007/s00167-016-4010-8

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  • DOI: https://doi.org/10.1007/s00167-016-4010-8

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