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Mansour E, Clarke HD, Spangehl MJ, Bingham JS. Periprosthetic Infection in Patients With Multiple Joint Arthroplasties. J Am Acad Orthop Surg 2024; 32:e106-e114. [PMID: 37831949 DOI: 10.5435/jaaos-d-23-00120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 09/05/2023] [Indexed: 10/15/2023] Open
Abstract
The number of total joint arthroplasties performed in the United States is increasing every year. Owing to the aging population and excellent long-term prosthesis survival, 45% of patients who undergo joint arthroplasty will receive two or more joint arthroplasties during their lifetimes. Periprosthetic joint infection (PJI) is among the most common complications after arthroplasty. Evaluation and treatment of PJI in patients with multiple joint arthroplasties is challenging, and no consensus exists for the optimal management. Multiple PJI can occur simultaneously, synchronous, or separated by extended time, metachronous. Patient risk factors for both scenarios have been reported and may guide evaluation and long-term management. Whether to perform joint aspiration for asymptomatic prosthesis in the presence of suspected PJI in patients with multiple joint arthroplasties is controversial. Furthermore, no consensus exists regarding whether patients who have multiple joint arthroplasties and develop PJI in a single joint should be considered for prolonged antibiotic prophylaxis to reduce the risk of future infections. Finally, the optimal treatment of synchronous joint infections whether by débridement, antibiotics and implant retention, and one-stage or two-stage revision has not been defined. This review will summarize the best information available and provide pragmatic management strategies.
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Affiliation(s)
- Elie Mansour
- From the Department of Orthopedic Surgery, Mayo Clinic, Phoenix, AZ
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Sambri A, Caldari E, Fiore M, Giannini C, Filippini M, Morante L, Rondinella C, Zamparini E, Tedeschi S, Viale P, De Paolis M. Synchronous Periprosthetic Joint Infections: A Scoping Review of the Literature. Diagnostics (Basel) 2022; 12:diagnostics12081841. [PMID: 36010192 PMCID: PMC9406556 DOI: 10.3390/diagnostics12081841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 07/26/2022] [Accepted: 07/29/2022] [Indexed: 11/16/2022] Open
Abstract
Prosthetic joint infections (PJIs) occurring in multiple joints at the same time (synchronous PJI) are an extremely rare complication, frequently associated with bacteremia, and are associated with high mortality rates. The presence of three or more prosthetic joints, rheumatoid arthritis, neoplasia, bacteremia and immune-modulating therapy seem to be the recurring risk factors for synchronous PJI. In case of PJIs, all other replaced joints should be considered as potentially infected and investigated if PJI is suspected. Treatments of synchronous multiple PJIs vary and must be decided on a case-by-case basis. However, the advantages of one-stage exchange seem to outweigh the two-stage protocol, as it decreases the number of necessary surgical procedures. Nonetheless, too few studies have been conducted to allow firm conclusions about the best handling of synchronous PJI. Thus, additional studies are needed to understand this devastating complication and to design the most appropriate diagnostic and therapeutic path.
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Affiliation(s)
- Andrea Sambri
- Orthopaedic and Traumatology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, 40138 Bologna, Italy; (E.C.); (M.F.); (C.G.); (M.F.); (L.M.); (C.R.); (M.D.P.)
- Correspondence:
| | - Emilia Caldari
- Orthopaedic and Traumatology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, 40138 Bologna, Italy; (E.C.); (M.F.); (C.G.); (M.F.); (L.M.); (C.R.); (M.D.P.)
| | - Michele Fiore
- Orthopaedic and Traumatology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, 40138 Bologna, Italy; (E.C.); (M.F.); (C.G.); (M.F.); (L.M.); (C.R.); (M.D.P.)
| | - Claudio Giannini
- Orthopaedic and Traumatology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, 40138 Bologna, Italy; (E.C.); (M.F.); (C.G.); (M.F.); (L.M.); (C.R.); (M.D.P.)
| | - Matteo Filippini
- Orthopaedic and Traumatology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, 40138 Bologna, Italy; (E.C.); (M.F.); (C.G.); (M.F.); (L.M.); (C.R.); (M.D.P.)
| | - Lorenzo Morante
- Orthopaedic and Traumatology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, 40138 Bologna, Italy; (E.C.); (M.F.); (C.G.); (M.F.); (L.M.); (C.R.); (M.D.P.)
| | - Claudia Rondinella
- Orthopaedic and Traumatology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, 40138 Bologna, Italy; (E.C.); (M.F.); (C.G.); (M.F.); (L.M.); (C.R.); (M.D.P.)
| | - Eleonora Zamparini
- Infectious Disease Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, 40138 Bologna, Italy; (E.Z.); (S.T.); (P.V.)
| | - Sara Tedeschi
- Infectious Disease Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, 40138 Bologna, Italy; (E.Z.); (S.T.); (P.V.)
- Department Medical and Surgical Sciences, DIMEC Alma Mater Studiorum, University of Bologna, 40126 Bologna, Italy
| | - Pierluigi Viale
- Infectious Disease Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, 40138 Bologna, Italy; (E.Z.); (S.T.); (P.V.)
- Department Medical and Surgical Sciences, DIMEC Alma Mater Studiorum, University of Bologna, 40126 Bologna, Italy
| | - Massimiliano De Paolis
- Orthopaedic and Traumatology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, 40138 Bologna, Italy; (E.C.); (M.F.); (C.G.); (M.F.); (L.M.); (C.R.); (M.D.P.)
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Humphrey TJ, Marchwiany D, Salimy MS, Nelson SB, Bedair HS, Melnic CM. Outcomes of Concurrent Endocarditis and Periprosthetic Joint Infection: A Retrospective Case Series of 16 Patients. Cureus 2022; 14:e24139. [PMID: 35573522 PMCID: PMC9106541 DOI: 10.7759/cureus.24139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2022] [Indexed: 11/20/2022] Open
Abstract
Introduction Concurrent diagnosis of periprosthetic joint infection (PJI) of total hip arthroplasty (THA) or total knee arthroplasty (TKA) with infectious endocarditis is a devastating clinical scenario infrequently documented in the literature. To date, no studies have fully described the orthopedic and infectious outcomes of patients with these concurrent diagnoses. The purpose of this study was to conduct a case series of patients with these diagnoses and document the orthopedic and infectious outcomes so that surgeons may effectively counsel patients regarding the gravity of the condition and the expected course of treatment. Methods This study is a retrospective case series using patient data from five hospitals within an academic healthcare system in the northeastern United States. Cases of concurrent endocarditis and THA or TKA PJI with a minimum of one-year follow-up were identified from January 2000 to January 2021. Basic statistics such as means, standard deviations, and percentages were used to identify trends within our series. Kaplan-Meier survivorship curves with log-rank tests were performed to determine if there were any differences in two-year mortality and joint survival (defined as needing explant) between patients who had cardiac surgery prior to surgical management for their PJI and those who had surgical management for PJI prior to cardiac surgery. Results A total of 18 joints in 16 patients with endocarditis and concurrent TKA or THA PJI were identified. All PJIs were managed surgically, with 14/18 (77.77%) of joint infections initially being managed by debridement, antibiotics, and implant retention (DAIR) and 4/18 (22.22%) of joint infections initially being managed by explant. Within the first six months of PJI diagnosis, 25% (4/16) of patients died of complications related to their infection, and one additional patient died of bacteremia just over a year after the initial PJI diagnosis. Of the 18 PJIs, 72.23% (13/18) had treatment failure, defined as any outcome equal to or worse than requiring chronic suppressive antibiotics for the infection. Due to low statistical power, we were not able to identify any differences in two-year mortality from PJI diagnosis (p=0.311) or joint survival (in terms of requiring explant) (p=0.420) depending on whether cardiac surgery or DAIR was performed first. Conclusions Concurrent infectious endocarditis and prosthetic joint infection is associated with high morbidity and mortality. Patients with these concurrent infections should be counseled that not only the associated mortality rate is high, but also the surgical treatment of their PJI has a high rate of treatment failure, including an explant following an initial DAIR, an explant with retained spacer, or a requirement of lifelong antibiotic suppression.
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Wouthuyzen-Bakker M, Sebillotte M, Arvieux C, Fernandez-Sampedro M, Senneville E, Barbero JM, Lora-Tamayo J, Aboltins C, Trebse R, Salles MJ, Kramer TS, Ferrari M, Garcia-Cañete J, Benito N, Diaz-Brito V, del Toro MD, Scarborough M, Soriano A. How to Handle Concomitant Asymptomatic Prosthetic Joints During an Episode of Hematogenous Periprosthetic Joint Infection, a Multicenter Analysis. Clin Infect Dis 2021; 73:e3820-e3824. [PMID: 32813012 PMCID: PMC9187975 DOI: 10.1093/cid/ciaa1222] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Prosthetic joints are at risk of becoming infected during an episode of bacteremia, especially during Staphylocococcus aureus bacteremia. However, it is unclear how often asymptomatic periprosthetic joint infection (PJI) occurs, and whether additional diagnostics should be considered. METHODS In this multicenter study, we retrospectively analyzed a cohort of patients with a late acute (hematogenous) PJI between 2005-2015 who had concomitant prosthetic joints in situ. Patients without at least 1 year of follow-up were excluded. RESULTS We included 91 patients with a hematogenous PJI and 108 concomitant prosthetic joints. The incident PJI was most frequently caused by Staphylococcus aureus (43%), followed by streptococci (26%) and Gram-negative rods (18%). Of 108 concomitant prosthetic joints, 13 were symptomatic, of which 10 were subsequently diagnosed as a second PJI. Of the 95 asymptomatic prosthetic joints, 1 PJI developed during the follow-up period and was classified as a "missed" PJI at the time of bacteremia with S. aureus (1.1%). Infected prosthetic joints were younger than the noninfected ones in 67% of cases, and prosthetic knees were affected more often than prosthetic hips (78%). CONCLUSIONS During an episode of hematogenous PJI, concomitant asymptomatic prosthetic joints have a very low risk of being infected, and additional diagnostic work-up for these joints is not necessary.
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Affiliation(s)
- Marjan Wouthuyzen-Bakker
- Correspondence: M. Wouthuyzen-Bakker, Infectious Disease Specialist, University Medical Center Groningen, Department of Medical Microbiology and Infection Prevention, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands ()
| | - Marine Sebillotte
- Department of Infectious Diseases and Intensive Care Medicine, Rennes University Hospital, Rennes, France
| | - Cédric Arvieux
- Department of Infectious Diseases and Intensive Care Medicine, Rennes University Hospital, Rennes, France
- Great West Reference centers for Complex Bone and Joint Infections (CRIOGO), Rennes, France
| | - Marta Fernandez-Sampedro
- Service of Infectious Diseases, Hospital Universitario Marqués de Valdecilla, University of Cantabria, Instituto de investigación sanitaria Valdecilla (IDIVAL), Santander, Spain
| | - Eric Senneville
- Department of Infectious Diseases, Lille, University Hospital Gustave Dron Hospital, Tourcoing, France
| | - José Maria Barbero
- Department of Internal Medicine. Hospital Universitario Principe de Asturias, Madrid, Spain
| | - Jaime Lora-Tamayo
- Department of Internal Medicine. Hospital Universitario 12 de Octubre. Instituto de Investigación i+12. Madrid, Spain
| | - Craig Aboltins
- The Department of Infectious Diseases, Northern Health, Melbourne, Australia
- The University of Melbourne, Northern Clinical School, Melbourne, Australia
| | - Rihard Trebse
- Service for Bone Infections, Valdoltra Orthopaedic Hospital, the Faculty of Medicine, University of Ljublijana, Ankaran, Slovenia
| | - Mauro José Salles
- Santa Casa de São Paulo School of Medical Sciences and Musculoskeletal infection group, Federal University of São Paulo, Brasil
| | - Tobias Siegfried Kramer
- Institute for hygiene and environmental medicine Charité-Universitätsmedizin Berlin, Germany
- Evangelisches Waldkrankenhaus Spandau, BerlinGermany
| | - Matteo Ferrari
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milan, Italy
| | - Joaquín Garcia-Cañete
- Department of Internal Medicine-Emergency, Instituto de Investigación Sanitaria (IIS)-Fundación Jiménez Díaz, Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - Natividad Benito
- Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau, Institut d’Investigació Biomèdica Sant Pau, Barcelona, Spain
- Department of Medicine. Universitat Autònoma de Barcelona, Spain
| | - Vicens Diaz-Brito
- Infectious Diseases Unit, Parc Sanitari Sant Joan de Deu, Sant Boi, Barcelona, Spain
| | - Maria Dolores del Toro
- Unidad Clínica de Enfermedades Infecciosa y Microbiología. Universidad de Sevilla. Instituto de Biomedicina de Sevilla (IBIS), Sevilla, Spain
| | - Matthew Scarborough
- Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals National Health Service (NHS) Foundation Trust, Oxford, England
| | - Alex Soriano
- Service of Infectious Diseases, Hospital Clínic, University of Barcelona, Barcelona, Spain
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Bell D, Manchal N, McNamara J, McDougall C. Reactive Arthritis from Influenza Vaccination: A Novel Presentation That Mimics Prosthetic Joint Infection: A Case Report. JBJS Case Connect 2021; 11:01709767-202112000-00067. [PMID: 35102026 DOI: 10.2106/jbjs.cc.21.00207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
CASE A 50-year-old woman with a history of bilateral knee replacements developed acute-onset bilateral painful knee effusions and inability to weight-bear. She was systemically well, but 2 days before the onset of her symptoms, she received an influenza vaccination. Synovial fluid analysis revealed white cell count (WCC) 190,000 × 109, 85% polymorphomuclear lymphocytes (PMN) on the left knee and WCC 252,200 × 109, 89% PMN on the right knee. Debridement and implant retention and polyethylene exchange was performed. Extended bacterial culture was negative as was 16s RNA polymerase chain reaction for remnants of bacterial DNA. No crystals were seen on any specimen. Both knees are stable and pain free at 12-month follow-up. CONCLUSION Reactive arthritis secondary to influenza vaccination is a rare condition that can mimic prosthetic joint infection.
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Affiliation(s)
- Douglas Bell
- Department of Orthopaedic Surgery, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Naveen Manchal
- Department of Infectious Diseases, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - John McNamara
- Department of Infectious Diseases, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Catherine McDougall
- Department of Orthopaedic Surgery, The Prince Charles Hospital, Chermside, Queensland, Australia
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Gausden EB, Pagnano MW, Perry KI, Suh GA, Berry DJ, Abdel MP. Synchronous Periprosthetic Joint Infections: High Mortality, Reinfection, and Reoperation. J Arthroplasty 2021; 36:3556-3561. [PMID: 34088568 DOI: 10.1016/j.arth.2021.05.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/05/2021] [Accepted: 05/09/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Synchronous periprosthetic joint infections (PJIs) are a catastrophic complication with potentially high mortality. We aimed to report mortality, risk of reinfection, revision, reoperation, and implant survivorship after synchronous PJIs. METHODS We identified 34 patients treated for PJI in more than one joint within a single 90-day period from 1990 to 2018. PJIs involved bilateral knee arthroplasty (27), bilateral hip arthroplasty (4), 1 knee arthroplasty and 1 elbow arthroplasty (1), 1 knee arthroplasty and 1 shoulder arthroplasty (1), and bilateral hip and knee arthroplasty (1). Irrigation and debridement with component retention was performed in 23 patients, implant resection in 10 patients, and a combination of irrigation and debridement with component retention and implant resection in 1 patient. A competing risk model was used to analyze implant survivorship, and Kaplan-Meier survival was used for patient mortality. Mean follow-up was 6 years. RESULTS Mortality was high at 18% at 30 days and 27% at 1 year. The 1-year cumulative incidence of any reinfection was 13% and 27% at 5 years. The 1-year cumulative incidence of any revision or implant removal was 6% and 20% at 5 years. The 1-year cumulative incidence of unplanned reoperation was 25% and 35% at 5 years. Rheumatoid arthritis was associated with increased risk of mortality (HR 7, P < .01), as was liver disease (HR 4, P = .02). CONCLUSION In the largest series to date, patients with synchronous PJIs had a high 30-day mortality rate of 18%, and one-fourth underwent unplanned reoperation within the first year.
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Affiliation(s)
| | - Mark W Pagnano
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | - Kevin I Perry
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | - Gina A Suh
- Division of Infectious Diseases, Department of Medicine Mayo Clinic, Rochester, MN
| | - Daniel J Berry
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | - Matthew P Abdel
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
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Thiesen DM, Mumin-Gündüz S, Gehrke T, Klaber I, Salber J, Suero E, Citak M. Synchronous Periprosthetic Joint Infections: The Need for All Artificial Joints to Be Aspirated Routinely. J Bone Joint Surg Am 2020; 102:283-291. [PMID: 31855870 DOI: 10.2106/jbjs.19.00835] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Periprosthetic joint infection (PJI) is a severe complication with increasing incidence. However, we are not aware of any robust data on patients having PJI at the same time in ≥2 joints that had undergone total joint arthroplasty, referred to as synchronous PJI throughout this article. The aims of this study were to investigate the probability of the development of synchronous PJI of another prosthetic joint and to identify possible clinical risk factors for the development of synchronous PJI. In addition, we aimed to determine whether routine aspiration of all other prosthetic joints was warranted after a diagnosis of PJI in a single joint. METHODS A total of 2,532 septic revision procedures were performed during the study period. In the final analysis, 644 patients (26 with synchronous PJI and 618 with non-synchronous PJI) with 1,508 prosthetic joints were included. The mean age (and standard deviation) was 71 ± 9.6 years. Using bivariate analyses, we calculated the odds of synchronous PJI as a function of various demographic and clinical variables. RESULTS A suspicious clinical presentation of the non-primary joint had the strongest association with synchronous PJI (odds ratio [OR], 58.5 [95% confidence interval (CI), 22.4 to 152.8]). Additional associations with synchronous PJI were detected for a history of neoplasia (OR, 12 [95% CI, 3.9 to 37.2]), the use of immune-modulating therapy (OR, 9.5 [95% CI, 3.4 to 26.2]), the presence of systemic inflammatory response syndrome or sepsis (OR, 8.4 [95% CI, 2.8 to 25]), and having ≥3 prosthetic joints (OR, 3.0 [95% CI, 1.37 to 6.64]). CONCLUSIONS Synchronous PJI is a rare but very serious complication and every prosthetic joint should be investigated meticulously. Suspicious clinical presentation, a history of neoplasia, sepsis, immune-modulating therapy, and ≥3 prosthetic joints were identified as risk factors and should increase the physician's vigilance. In the case of PJI, aspiration of each joint that had undergone total joint arthroplasty should be considered. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Darius M Thiesen
- Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Hamburg, Germany.,Department of Trauma, Hand and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Seval Mumin-Gündüz
- Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Hamburg, Germany.,Department of Surgery, Ruhr-University Bochum, Bochum, Germany
| | - Thorsten Gehrke
- Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Hamburg, Germany
| | - Ianiv Klaber
- Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Hamburg, Germany
| | - Jochen Salber
- Department of Surgery, Ruhr-University Bochum, Bochum, Germany
| | - Eduardo Suero
- Department of General, Trauma and Reconstructive Surgery, Ludwig Maximilian University of Munich, Munich, Germany
| | - Mustafa Citak
- Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Hamburg, Germany
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Stévignon T, Mouton A, Meyssonnier V, Kerroumi Y, Yazigi A, Aubert T, Lhotellier L, Le Strat V, Passeron D, Graff W, Zeller V, Heym B, Marmor S. Haematogenous prosthetic knee infections: Prospective cohort study of 58 patients. Orthop Traumatol Surg Res 2019; 105:647-651. [PMID: 31047841 DOI: 10.1016/j.otsr.2019.02.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 01/25/2019] [Accepted: 02/01/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Prosthetic joint infection (PJI) is a rare (incidence, 0.15% to 0.9%) but serious complication of knee arthroplasty. Haematogenous PJI of the knee (KhPJI) which accounts for 10% of cases, has been less studied than PJI due to other mechanisms. The primary objective of this study in patients with KhPJI of the knee was to determine the 2-year infection eradication failure rate after either exchange arthroplasty or arthrotomy/synovectomy/irrigation (ASI), combined with prolonged peri-operative antibiotic therapy, at a referral centre for complex osteo-articular infections. HYPOTHESIS ASI within 2 weeks after symptom onset and one-stage exchange arthroplasty produce similar 2-year success rates in patients with KhPJI of the knee. MATERIAL AND METHODS A prospective observational cohort study was performed in patients managed for PJI of the knee between 2003 and 2015. The primary outcome measure was the occurrence of a septic event or of KhPJI -related death during a minimum follow-up of 2 years. RESULTS Of 265 patients with PJI after total knee arthroplasty, 58 (22.1%) had KhPJI with onset more than 3 months after the last arthroplasty procedure and were included in the study. Among them, one-third had immune deficiencies. The most common causative organisms were streptococci (n=25, 43%) and Staphylococcusaureus (n=20, 34%). The primary focus of infection was identified in only 64% of patients and was most often cutaneous (n=19, 33%) or dental (n=11, 19%). A septic event or KhPJI-related death occurred in 5/34 (15%) patients after one-stage exchange arthroplasty and 6/19 (32%) patients after ASI within 15 days after symptom onset (p=0.03). Patient characteristics, type of prosthesis, and causative organism were not significantly associated with failure to eradicate the infection. CONCLUSION ASI carried a high failure rate despite being performed within 15 days after symptom onset. One-stage exchange arthroplasty seems to be the best surgical option, particularly as the exact time of symptom onset may be difficult to determine. Identifying and eradicating the primary focus of infection is crucial. LEVEL OF EVIDENCE II, low-powered prospective cohort study.
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Affiliation(s)
- Thomas Stévignon
- Service de chirurgie osseuse et traumatologique, centre de référence des infections ostéo-articulaires complexes, groupe hospitalier Diaconesses-Croix Saint-Simon, 125, rue d'Avron, 75020 Paris, France.
| | - Antoine Mouton
- Service de chirurgie osseuse et traumatologique, centre de référence des infections ostéo-articulaires complexes, groupe hospitalier Diaconesses-Croix Saint-Simon, 125, rue d'Avron, 75020 Paris, France
| | - Vanina Meyssonnier
- Service de chirurgie osseuse et traumatologique, centre de référence des infections ostéo-articulaires complexes, groupe hospitalier Diaconesses-Croix Saint-Simon, 125, rue d'Avron, 75020 Paris, France
| | - Younes Kerroumi
- Service de chirurgie osseuse et traumatologique, centre de référence des infections ostéo-articulaires complexes, groupe hospitalier Diaconesses-Croix Saint-Simon, 125, rue d'Avron, 75020 Paris, France
| | - Alexandre Yazigi
- Service de chirurgie oncologique, institut Curie, 35 rue Dailly, 92210 Saint-Cloud, France
| | - Thomas Aubert
- Service de chirurgie osseuse et traumatologique, centre de référence des infections ostéo-articulaires complexes, groupe hospitalier Diaconesses-Croix Saint-Simon, 125, rue d'Avron, 75020 Paris, France
| | - Luc Lhotellier
- Service de chirurgie osseuse et traumatologique, centre de référence des infections ostéo-articulaires complexes, groupe hospitalier Diaconesses-Croix Saint-Simon, 125, rue d'Avron, 75020 Paris, France
| | - Vincent Le Strat
- Service de chirurgie osseuse et traumatologique, centre de référence des infections ostéo-articulaires complexes, groupe hospitalier Diaconesses-Croix Saint-Simon, 125, rue d'Avron, 75020 Paris, France
| | - Dorick Passeron
- Service de chirurgie osseuse et traumatologique, centre de référence des infections ostéo-articulaires complexes, groupe hospitalier Diaconesses-Croix Saint-Simon, 125, rue d'Avron, 75020 Paris, France
| | - Wilfrid Graff
- Service de chirurgie osseuse et traumatologique, centre de référence des infections ostéo-articulaires complexes, groupe hospitalier Diaconesses-Croix Saint-Simon, 125, rue d'Avron, 75020 Paris, France
| | - Valérie Zeller
- Service de chirurgie osseuse et traumatologique, centre de référence des infections ostéo-articulaires complexes, groupe hospitalier Diaconesses-Croix Saint-Simon, 125, rue d'Avron, 75020 Paris, France
| | - Béate Heym
- Service de chirurgie osseuse et traumatologique, centre de référence des infections ostéo-articulaires complexes, groupe hospitalier Diaconesses-Croix Saint-Simon, 125, rue d'Avron, 75020 Paris, France
| | - Simon Marmor
- Service de chirurgie osseuse et traumatologique, centre de référence des infections ostéo-articulaires complexes, groupe hospitalier Diaconesses-Croix Saint-Simon, 125, rue d'Avron, 75020 Paris, France
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Abdel Karim M, Andrawis J, Bengoa F, Bracho C, Compagnoni R, Cross M, Danoff J, Della Valle CJ, Foguet P, Fraguas T, Gehrke T, Goswami K, Guerra E, Ha YC, Klaber I, Komnos G, Lachiewicz P, Lausmann C, Levine B, Leyton-Mange A, McArthur BA, Mihalič R, Neyt J, Nuñez J, Nunziato C, Parvizi J, Perka C, Reisener MJ, Rocha CH, Schweitzer D, Shivji F, Shohat N, Sierra RJ, Suleiman L, Tan TL, Vasquez J, Ward D, Wolf M, Zahar A. Hip and Knee Section, Diagnosis, Algorithm: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34:S339-S350. [PMID: 30348566 DOI: 10.1016/j.arth.2018.09.018] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Chotanaphuti T, Courtney PM, Fram B, In den Kleef NJ, Kim TK, Kuo FC, Lustig S, Moojen DJ, Nijhof M, Oliashirazi A, Poolman R, Purtill JJ, Rapisarda A, Rivero-Boschert S, Veltman ES. Hip and Knee Section, Treatment, Algorithm: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34:S393-S397. [PMID: 30348575 DOI: 10.1016/j.arth.2018.09.024] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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