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Two-stage Exchange Knee Arthroplasty: Does Resistance of the Infecting Organism Influence the Outcome?

  • Symposium: Papers Presented at the 2009 Meeting of the Musculoskeletal Infection Society
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Periprosthetic joint infection after TKA is a challenging complication. Two-stage exchange arthroplasty is the accepted standard of care, but reported failure rates are increasing. It has been suggested this is due to the increased prevalence of methicillin-resistant infections.

Questions/purposes

We asked the following questions: (1) What is the reinfection rate after two-stage exchange arthroplasty? (2) Which risk factors predict failure? (3) Which variables are associated with acquiring a resistant organism periprosthetic joint infection?

Methods

This was a case-control study of 102 patients with infected TKA who underwent a two-stage exchange arthroplasty. Ninety-six patients were followed for a minimum of 2 years (mean, 34.5 months; range, 24–90.1 months). Cases were defined as failures of two-stage exchange arthroplasty.

Results

Two-stage exchange arthroplasty was successful in controlling the infection in 70 patients (73%). Patients who failed two-stage exchange arthroplasty were 3.37 times more likely to have been originally infected with a methicillin-resistant organism. Older age, higher body mass index, and history of thyroid disease were predisposing factors to infection with a methicillin-resistant organism.

Conclusions

Innovative interventions are needed to improve the effectiveness of two-stage exchange arthroplasty for TKA infection with a methicillin-resistant organism as current treatment protocols may not be adequate for control of these virulent pathogens.

Level of Evidence

Level IV, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

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Authors and Affiliations

  1. The Rothman Institute of Orthopedics at Thomas Jefferson University, 925 Chestnut Street, 5th Floor, Philadelphia, PA, 19107, USA

    Mark F. Kurd MD, Elie Ghanem MD, Jill Steinbrecher BS & Javad Parvizi MD, FRCS

Authors
  1. Mark F. Kurd MD
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  2. Elie Ghanem MD
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  3. Jill Steinbrecher BS
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  4. Javad Parvizi MD, FRCS
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Corresponding author

Correspondence to Javad Parvizi MD, FRCS.

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Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

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Kurd, M.F., Ghanem, E., Steinbrecher, J. et al. Two-stage Exchange Knee Arthroplasty: Does Resistance of the Infecting Organism Influence the Outcome?. Clin Orthop Relat Res 468, 2060–2066 (2010). https://doi.org/10.1007/s11999-010-1296-6

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  • DOI: https://doi.org/10.1007/s11999-010-1296-6

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