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

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Abstract

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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Acknowledgments

We thank all colleagues of the Orthopedic Service and the Laboratory of Bacteriology for their clinical help and Dr. Anne Lübbeke for data retrieval.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Orthopedic Surgery Service, Geneva University Hospitals & Faculty of Medicine, University of Geneva, 4, Rue Gabrielle Perret-Gentil, 1211, Geneva 14, Switzerland

    Line Zürcher-Pfund, Ilker Uçkay, Laurence Legout, Axel Gamulin & Robin Peter

  2. Service of Infectious Diseases, Geneva University Hospitals & Faculty of Medicine, University of Geneva, 4, Rue Gabrielle Perret-Gentil, 1211, Geneva 14, Switzerland

    Ilker Uçkay & Pierre Vaudaux

Authors
  1. Line Zürcher-Pfund
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  2. Ilker Uçkay
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  3. Laurence Legout
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  4. Axel Gamulin
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  5. Pierre Vaudaux
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  6. Robin Peter
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Corresponding author

Correspondence to Ilker Uçkay.

Additional information

Line Zürcher-Pfund and Ilker Uçkay contributed equally to this work as first authors.

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Zürcher-Pfund, L., Uçkay, I., Legout, L. et al. Pathogen-driven decision for implant retention in the management of infected total knee prostheses. International Orthopaedics (SICOT) 37, 1471–1475 (2013). https://doi.org/10.1007/s00264-013-1923-4

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  • DOI: https://doi.org/10.1007/s00264-013-1923-4

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