1887

Abstract

Periprosthetic joint infections caused by methicillin-resistant (MRSA-PJIs) are rare, with only a few studies reporting the treatment outcomes and even fewer reporting outcomes with one-stage exchange.

This study aims to analyse the outcomes of one-stage exchange in the management of MRSA-PJIs.

Patients with MRSA-PJI of the hip and knee, who were treated with a one-stage exchange between 2001 and 2018 were enrolled in this study. The final cohort comprised of 29 patients, which included 23 hips and six knees. The mean follow-up was 5.3 years (1–9 years). Reinfection and complications rates after the one-stage exchange were analysed.

Overall infection control could be achieved in 93.1 % (27 out of 29 patients). The overall revision rate was 31.0% (9 patients), with three patients requiring an in-hospital revision (10.3 %). Six patients had to be revised after hospital discharge (20.7 %). Of the two reinfections, one had a growth of MRSA while the other was of methicillin-sensitive .

One-stage exchange surgery using current techniques could improve surgical outcomes with excellent results in the management of MRSA-PJIs.

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2020-07-08
2020-09-20
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References

  1. Bozic KJ, Ries MD. The impact of infection after total hip arthroplasty on hospital and surgeon resource utilization. J Bone Joint Surg Am 2005; 87:1746–1751 [CrossRef][PubMed]
    [Google Scholar]
  2. Kurtz SM, Lau E, Schmier J, Ong KL, Zhao K et al. Infection burden for hip and knee arthroplasty in the United States. J Arthroplasty 2008; 23:984–991 [CrossRef][PubMed]
    [Google Scholar]
  3. Kheir MM, Tan TL, Higuera C, George J, Della Valle CJ et al. Periprosthetic joint infections caused by enterococci have poor outcomes. J Arthroplasty 2017; 32:933–947 [CrossRef][PubMed]
    [Google Scholar]
  4. Aggarwal VK, Bakhshi H, Ecker NU, Parvizi J, Gehrke T et al. Organism profile in periprosthetic joint infection: pathogens differ at two arthroplasty infection referral centers in Europe and in the United States. J Knee Surg 2014; 27:399–406 [CrossRef][PubMed]
    [Google Scholar]
  5. Rosteius T, Jansen O, Fehmer T, Baecker H, Citak M et al. Evaluating the microbial pattern of periprosthetic joint infections of the hip and knee. J Med Microbiol 2018; 67:1608–1613 [CrossRef][PubMed]
    [Google Scholar]
  6. Zeller V, Kerroumi Y, Meyssonnier V, Heym B, Metten M-A et al. Analysis of postoperative and hematogenous prosthetic joint-infection microbiological patterns in a large cohort. J Infect 2018; 76:328–334 [CrossRef][PubMed]
    [Google Scholar]
  7. Gundtoft PH, Pedersen AB, Schønheyder HC, Møller JK, Overgaard S et al. One-Year incidence of prosthetic joint infection in total hip arthroplasty: a cohort study with linkage of the Danish hip arthroplasty register and Danish microbiology databases. Osteoarthritis Cartilage 2017; 25:685–693 [CrossRef][PubMed]
    [Google Scholar]
  8. Hischebeth GT, Randau TM, Ploeger MM, Friedrich MJ, Kaup E et al. Staphylococcus aureus versus Staphylococcus epidermidis in periprosthetic joint infection-Outcome analysis of methicillin-resistant versus methicillin-susceptible strains. Diagn Microbiol Infect Dis 2019; 93:125–130 [CrossRef][PubMed]
    [Google Scholar]
  9. Parvizi J, Azzam K, Ghanem E, Austin MS, Rothman RH et al. Periprosthetic infection due to resistant staphylococci: serious problems on the horizon. Clin Orthop Relat Res 2009; 467:1732–1739 [CrossRef][PubMed]
    [Google Scholar]
  10. Parvizi J, Pawasarat IM, Azzam KA, Joshi A, Hansen EN et al. Periprosthetic joint infection: the economic impact of methicillin-resistant infections. J Arthroplasty 2010; 25:103–107 [CrossRef][PubMed]
    [Google Scholar]
  11. Kordelle J, Frommelt L, Klüber D et al. Ergebnisse einzeitiger Endoprothesenwechsel bei periprothetischer Infektion durch einen methicillin-resistenten Staphylococcus aureus (MRSA) (results of one-stage endoprosthesis revision in periprosthetic infection cause by methicillin-resistant Staphylococcus aureus). Z Orthop Ihre Grenzgeb 2000; 138:240–244
    [Google Scholar]
  12. Parvizi J, Gehrke T, Chen AF. Proceedings of the International consensus on periprosthetic joint infection. Bone Joint J 2013; 95-B:1450–1452 [CrossRef][PubMed]
    [Google Scholar]
  13. Sharqzad AS, Cavalheiro C, Zahar A, Lausmann C, Gehrke T et al. Blood loss and allogeneic transfusion for surgical treatment of periprosthetic joint infection: a comparison of one- vs. two-stage exchange total hip arthroplasty. Int Orthop 2019; 43:2025–2030 [CrossRef][PubMed]
    [Google Scholar]
  14. Gehrke T, Zahar A, Kendoff D. One-Stage exchange: it all began here. Bone Joint J 2013; B95:77–83
    [Google Scholar]
  15. Rowan FE, Donaldson MJ, Pietrzak JR, Haddad FS. The role of one-stage exchange for prosthetic joint infection. Curr Rev Musculoskelet Med 2018; 11:370–379 [CrossRef][PubMed]
    [Google Scholar]
  16. Masters JPM, Smith NA, Foguet P, Reed M, Parsons H et al. A systematic review of the evidence for single stage and two stage revision of infected knee replacement. BMC Musculoskelet Disord 2013; 14:222 [CrossRef][PubMed]
    [Google Scholar]
  17. Yaghmour K, Chisari E, Khan W. Single-Stage revision surgery in infected total knee arthroplasty: a PRISMA systematic review. J Clin Med 2019; 8:E174174 [CrossRef][PubMed]
    [Google Scholar]
  18. Abdelaziz H, Grüber H, Gehrke T, Salber J, Citak M et al. What are the factors associated with Re-revision after one-stage revision for periprosthetic joint infection of the hip? A case-control study. Clin Orthop Relat Res 2019; 477:2258–2263 [CrossRef][PubMed]
    [Google Scholar]
  19. Citak M, Friedenstab J, Abdelaziz H, Suero EM, Zahar A et al. Risk factors for failure after 1-Stage exchange total knee arthroplasty in the management of periprosthetic joint infection. J Bone Joint Surg Am 2019; 101:1061–1069 [CrossRef][PubMed]
    [Google Scholar]
  20. Bradbury T, Fehring TK, Taunton M, Hanssen A, Azzam K et al. The fate of acute methicillin-resistant Staphylococcus aureus periprosthetic knee infections treated by open debridement and retention of components. J Arthroplasty 2009; 24:101–104 [CrossRef][PubMed]
    [Google Scholar]
  21. Duque AF, Post ZD, Lutz RW, Orozco FR, Pulido SH et al. Is there still a role for irrigation and debridement with liner exchange in acute periprosthetic total knee infection?. J Arthroplasty 2017; 32:1280–1284 [CrossRef][PubMed]
    [Google Scholar]
  22. Siddiqui R, Khan NA. Infection control strategy by killing drug-resistant bacteria. Pathog Glob Health 2013; 107:215–216 [CrossRef][PubMed]
    [Google Scholar]
  23. Soriano A, García S, Bori G, Almela M, Gallart X et al. Treatment of acute post-surgical infection of joint arthroplasty. Clin Microbiol Infect 2006; 12:930–933 [CrossRef][PubMed]
    [Google Scholar]
  24. Lora-Tamayo J, Murillo O, Iribarren JA, Soriano A, Sánchez-Somolinos M et al. A large multicenter study of methicillin-susceptible and methicillin-resistant Staphylococcus aureus prosthetic joint infections managed with implant retention. Clin Infect Dis 2013; 56:182–194 [CrossRef][PubMed]
    [Google Scholar]
  25. Kilgus DJ, Howe DJ, Strang A. Results of periprosthetic hip and knee infections caused by resistant bacteria. Clin Orthop Relat Res 2002; 404:116–124 [CrossRef][PubMed]
    [Google Scholar]
  26. Singer J, Merz A, Frommelt L, Fink B. High rate of infection control with one-stage revision of septic knee prostheses excluding MRSA and MRSE. Clin Orthop Relat Res 2012; 470:1461–1471 [CrossRef][PubMed]
    [Google Scholar]
  27. Whiteside LA, Peppers M, Nayfeh TA, Roy ME. Methicillin-resistant Staphylococcus aureus in TKA treated with revision and direct intra-articular antibiotic infusion. Clin Orthop Relat Res 2011; 469:26–33 [CrossRef][PubMed]
    [Google Scholar]
  28. Zimmerli W, Sendi P. Role of Rifampin against Staphylococcal biofilm infections in vitro, in animal models, and in orthopedic-device-related infections. Antimicrob Agents Chemother 2019; 63: [CrossRef][PubMed]
    [Google Scholar]
  29. Davis SC, Harding A, Gil J, Parajon F, Valdes J et al. Effectiveness of a polyhexanide irrigation solution on methicillin-resistant Staphylococcus aureus biofilms in a porcine wound model. Int Wound J 2017; 14:937–944 [CrossRef][PubMed]
    [Google Scholar]
  30. Roth B, Brill FHH. Polihexanide for wound treatment-how it began. Skin Pharmacol Physiol 2010; 23 Suppl:4–6 [CrossRef][PubMed]
    [Google Scholar]
  31. Abblitt WP, Ascione T, Bini S, Bori G, Brekke AC et al. Hip and knee section, outcomes: proceedings of international consensus on orthopedic infections. J Arthroplasty 2019; 34:S487–S495 [CrossRef][PubMed]
    [Google Scholar]
  32. Thakrar RR, Horriat S, Kayani B, Haddad FS. Indications for a single-stage exchange arthroplasty for chronic prosthetic joint infection: a systematic review. Bone Joint J 2019; 101-B:19–24 [CrossRef][PubMed]
    [Google Scholar]
  33. Haddad FS, Sukeik M, Alazzawi S. Is single-stage revision according to a strict protocol effective in treatment of chronic knee arthroplasty infections?. Clin Orthop Relat Res 2015; 473:8–14 [CrossRef][PubMed]
    [Google Scholar]
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