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75% success rate after open debridement, exchange of tibial insert, and antibiotics in knee prosthetic joint infections.

Holmberg, Anna LU ; Thórhallsdóttir, Valdís Gudrún; Robertsson, Otto LU ; W-Dahl, Annette LU and Stefansdottir, Anna LU (2015) In Acta Orthopaedica 86(4). p.457-462
Abstract
Background and purpose - Prosthetic joint infection (PJI) is a leading cause of early revision after total knee arthroplasty (TKA). Open debridement with exchange of tibial insert allows treatment of infection with retention of fixed components. We investigated the success rate of this procedure in the treatment of knee PJIs in a nationwide material, and determined whether the results were affected by microbiology, antibiotic treatment, or timing of debridement. Patients and methods - 145 primary TKAs revised for the first time, due to infection, with debridement and exchange of the tibial insert were identified in the Swedish Knee Arthroplasty Register (SKAR). Staphylococcus aureus was the most common pathogen (37%) followed by... (More)
Background and purpose - Prosthetic joint infection (PJI) is a leading cause of early revision after total knee arthroplasty (TKA). Open debridement with exchange of tibial insert allows treatment of infection with retention of fixed components. We investigated the success rate of this procedure in the treatment of knee PJIs in a nationwide material, and determined whether the results were affected by microbiology, antibiotic treatment, or timing of debridement. Patients and methods - 145 primary TKAs revised for the first time, due to infection, with debridement and exchange of the tibial insert were identified in the Swedish Knee Arthroplasty Register (SKAR). Staphylococcus aureus was the most common pathogen (37%) followed by coagulase-negative staphylococci (CNS) (23%). Failure was defined as death before the end of antibiotic treatment, revision of major components due to infection, life-long antibiotic treatment, or chronic infection. Results - The overall healing rate was 75%. The type of infecting pathogen did not statistically significantly affect outcome. Staphylococcal infections treated without a combination of antibiotics including rifampin had a higher failure rate than those treated with rifampin (RR = 4, 95% CI: 2-10). In the 16 cases with more than 3 weeks of symptoms before treatment, the healing rate was 62%, as compared to 77% in the other cases (p = 0.2). The few patients with a revision model of prosthesis at primary operation had a high failure rate (5 of 8). Interpretation - Good results can be achieved by open debridement with exchange of tibial insert. It is important to use an antibiotic combination including rifampin in staphylococcal infections. (Less)
Please use this url to cite or link to this publication:
author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Acta Orthopaedica
volume
86
issue
4
pages
457 - 462
publisher
Taylor & Francis
external identifiers
  • pmid:25753311
  • wos:000359106700011
  • scopus:84937847715
ISSN
1745-3682
DOI
10.3109/17453674.2015.1026756
language
English
LU publication?
yes
id
2d6c37a7-5059-4604-8c77-760a00fdecad (old id 5264962)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/25753311?dopt=Abstract
date added to LUP
2015-04-02 16:03:11
date last changed
2017-11-05 03:17:49
@article{2d6c37a7-5059-4604-8c77-760a00fdecad,
  abstract     = {Background and purpose - Prosthetic joint infection (PJI) is a leading cause of early revision after total knee arthroplasty (TKA). Open debridement with exchange of tibial insert allows treatment of infection with retention of fixed components. We investigated the success rate of this procedure in the treatment of knee PJIs in a nationwide material, and determined whether the results were affected by microbiology, antibiotic treatment, or timing of debridement. Patients and methods - 145 primary TKAs revised for the first time, due to infection, with debridement and exchange of the tibial insert were identified in the Swedish Knee Arthroplasty Register (SKAR). Staphylococcus aureus was the most common pathogen (37%) followed by coagulase-negative staphylococci (CNS) (23%). Failure was defined as death before the end of antibiotic treatment, revision of major components due to infection, life-long antibiotic treatment, or chronic infection. Results - The overall healing rate was 75%. The type of infecting pathogen did not statistically significantly affect outcome. Staphylococcal infections treated without a combination of antibiotics including rifampin had a higher failure rate than those treated with rifampin (RR = 4, 95% CI: 2-10). In the 16 cases with more than 3 weeks of symptoms before treatment, the healing rate was 62%, as compared to 77% in the other cases (p = 0.2). The few patients with a revision model of prosthesis at primary operation had a high failure rate (5 of 8). Interpretation - Good results can be achieved by open debridement with exchange of tibial insert. It is important to use an antibiotic combination including rifampin in staphylococcal infections.},
  author       = {Holmberg, Anna and Thórhallsdóttir, Valdís Gudrún and Robertsson, Otto and W-Dahl, Annette and Stefansdottir, Anna},
  issn         = {1745-3682},
  language     = {eng},
  number       = {4},
  pages        = {457--462},
  publisher    = {Taylor & Francis},
  series       = {Acta Orthopaedica},
  title        = {75% success rate after open debridement, exchange of tibial insert, and antibiotics in knee prosthetic joint infections.},
  url          = {http://dx.doi.org/10.3109/17453674.2015.1026756},
  volume       = {86},
  year         = {2015},
}