75% success rate after open debridement, exchange of tibial insert, and antibiotics in knee prosthetic joint infections.
(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:
https://lup.lub.lu.se/record/5264962
- author
- Holmberg, Anna LU ; Thórhallsdóttir, Valdís Gudrún ; Robertsson, Otto LU ; W-Dahl, Annette LU and Stefansdottir, Anna LU
- organization
- publishing date
- 2015
- 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
- pmid:25753311
- ISSN
- 1745-3682
- DOI
- 10.3109/17453674.2015.1026756
- language
- English
- LU publication?
- yes
- additional info
- The information about affiliations in this record was updated in December 2015. The record was previously connected to the following departments: Division of Infection Medicine (SUS) (013008000), Department of Orthopaedics (Lund) (013028000)
- 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
- 2016-04-01 10:43:51
- date last changed
- 2022-04-20 05:40:48
@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}},
doi = {{10.3109/17453674.2015.1026756}},
volume = {{86}},
year = {{2015}},
}