The Journal of Bone and Joint Surgery (American). 2007;89:1227-1231.
doi:10.2106/JBJS.E.01192
© 2007 The Journal of Bone and Joint Surgery, Inc.
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow CME: Take the activity for this article:
 Adult Knee Reconstruction Test 15: Summer 2007 (publication date August 15,...
Right arrow [Supplementary Material]
Right arrow Letters to the Editor: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when Letters to the Editor are posted
Right arrow Alert me if a correction is posted
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrow Rights and Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Mittal, Y.
Right arrow Articles by Osmon, D.
Right arrow Search for Related Content
PubMed
Right arrow Articles by Mittal, Y.
Right arrow Articles by Osmon, D.
Related Collections
Right arrow Adult Knee
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us   Add to Facebook   Add to Technorati   Add to Twitter  
What's this?

Two-Stage Reimplantation for Periprosthetic Knee Infection Involving Resistant Organisms

Yogesh Mittal, MD1, Thomas K. Fehring, MD2, Arlen Hanssen, MD3, Camelia Marculescu, MD3, Susan M. Odum, MEd2 and Douglas Osmon, MD3

1 816 West Juneau, Broken Arrow, OK 74012
2 OrthoCarolina Hip and Knee Center, 1915 Randolph Road, Charlotte, NC 28270. E-mail address for T.K. Fehring: Thomas.Fehring{at}orthocarolina.com
3 Mayo Clinic, 200 First Street S.W., Rochester, MN 55905

Investigation performed at the OrthoCarolina Hip and Knee Center, Charlotte, North Carolina, and the Mayo Clinic, Rochester, Minnesota

Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants of less than $10,000 from DePuy, a Johnson and Johnson company. In addition, one or more of the authors or a member of his or her immediate family received, in any one year, payments or other benefits in excess of $10,000 or a commitment or agreement to provide such benefits from a commercial entity (consulting fees from DePuy and Stryker). No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

Background: Two-stage reimplantation is the most accepted mode of treatment for patients with a periprosthetic infection following total knee arthroplasty. Most studies, however, do not stratify their results on the basis of the type of infecting organism. The purpose of this study was to determine the outcomes for patients who had two-stage reimplantation for the treatment of infection with a resistant organism, methicillin-resistant Staphylococcus aureus or methicillin-resistant Staphylococcus epidermidis, at the site of a total knee replacement.

Methods: A multicenter study was performed to review the cases of all patients treated between 1987 and 2003 because of an infection with methicillin-resistant Staphylococcus aureus or methicillin-resistant Staphylococcus epidermidis organisms at the site of a total knee replacement. The prevalence of reinfection following two-stage reimplantation was determined. Variables that may influence the outcome, such as the duration and type of intravenous antibiotics administered, previous surgery, and comorbidities of the host, were analyzed.

Results: We identified thirty-seven patients who had an infection with a resistant organism. All patients had negative cultures at the time of reimplantation. Four of the thirty-seven patients had a reinfection with the same organism, while five had a reinfection with a different organism. None of the variables noted above were found to be significantly associated with reinfection, on the basis of the numbers available.

Conclusions: Reports in the literature have discouraged reimplantation for the treatment of an infection with a resistant organism at the site of a total knee replacement. While 24% of the patients in this series had a reinfection, 14% had a reinfection with a different organism. We believe that two-stage reimplantation remains a viable treatment option for patients who have an infection with a resistant organism at the site of a total knee replacement.

Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Facebook Facebook   Add to Technorati Technorati   Add to Twitter Twitter    What's this?


This article has been cited by other articles:


Home page
 J Antimicrob ChemotherHome page
P. Bejon, A. Berendt, B. L. Atkins, N. Green, H. Parry, S. Masters, P. Mclardy-Smith, R. Gundle, and I. Byren
Two-stage revision for prosthetic joint infection: predictors of outcome and the role of reimplantation microbiology
J. Antimicrob. Chemother., March 1, 2010; 65(3): 569 - 575.
[Abstract] [Full Text] [PDF]

Home page
 BMJHome page
P. C Matthews, A. R Berendt, M. A McNally, and I. Byren
Diagnosis and management of prosthetic joint infection
BMJ, May 29, 2009; 338(may29_1): b1773 - b1773.
[Full Text]

Home page
 JBJSHome page
C. A. Deirmengian and J. H. Lonner
What's New in Adult Reconstructive Knee Surgery
J. Bone Joint Surg. Am., November 1, 2008; 90(11): 2556 - 2565.
[Full Text] [PDF]