Risk of methicillin-resistant staphylococcus aureus prosthetic joint infection in elective total hip and knee arthroplasty following eradication therapy

Evaluating Failure Mechanisms for Total Talus Replacement: Contemporary Review

BACKGROUND

As total talus replacement (TTR) grows in popularity as a salvage option for talar collapse, a critical evaluation of the complications associated with this procedure is indicated.

METHODS

In this review of the literature, we present a patient report and provide a review of several complications seen after TTR, including ligamentous instability, infection, and adjacent joint osteoarthritis, which we have encountered in our practice.

RESULTS

Total talus replacement has the potential to reduce pain and preserve range of motion. However, the treating surgeon must be cognizant of the variety of adverse outcomes. We have presented cases of potential devastating complications from our own clinical experience and the literature.

CONCLUSIONS

In conclusion, TTR may have utility in the properly selected patient with end-stage talar collapse, but implant composition, indications, and patient demographic variables complicate the interpretation of the literature.Levels of Evidence: Level III.

Positive Preoperative Colonization With Methicillin Resistant Staphylococcus Aureus Is Associated With Inferior Postoperative Outcomes in Patients Undergoing Total Joint Arthroplasty

BACKGROUND

The impact of preoperative nasal colonization with methicillin resistant staphylococcus aureus (MRSA) on total joint arthroplasty (TJA) outcomes is not well understood. This study aimed to evaluate complications following TJA based on patients' preoperative staphylococcal colonization status.

METHODS

We retrospectively analyzed all patients undergoing primary TJA between 2011 and 2022 who completed a preoperative nasal culture swab for staphylococcal colonization. Patients were 1:1:1 propensity matched using baseline characteristics, and stratified into 3 groups based on their colonization status: MRSA positive (MRSA+), methicillin sensitive staphylococcus aureus positive (MSSA+), and MSSA/MRSA negative (MSSA/MRSA-). All MRSA+ and MSSA + underwent decolonization with 5% povidone iodine, with the addition of intravenous vancomycin for MRSA + patients. Surgical outcomes were compared between groups. Of the 33,854 patients evaluated, 711 were included in final matched analysis (237 per group).

RESULTS

The MRSA + TJA patients had longer hospital lengths of stay (P = .008), were less likely to discharge home (P = .003), and had higher 30-day (P = .030) and 90-day (P = .033) readmission rates compared to MSSA+ and MSSA/MRSA-patients, though 90-day major and minor complications were comparable across groups. MRSA + patients had higher rates of all-cause (P = .020), aseptic (P = .025) and septic revisions (P = .049) compared to the other cohorts. These findings held true for both total knee and total hip arthroplasty patients when analyzed separately.

CONCLUSION

Despite targeted perioperative decolonization, MRSA + patients undergoing TJA have longer lengths of stay, higher readmission rates, and higher septic and aseptic revision rates. Surgeons should consider patients' preoperative MRSA colonization status when counseling on the risks of TJA.

Risk of methicillin-resistant Staphylococcus aureus prosthetic joint infection in elective total hip and knee arthroplasty following eradication therapy

Re-screening following methicillin-resistant Staphylococcus aureus (MRSA) decolonization will be helpful to minimize the development of prosthetic joint infection among MRSA colonizers.