TREATMENT OF INFECTION AFTER TOTAL KNEE ARTHROPLASTY
To identify and compare the rate of success of therapeutic modalities applied in surgeries for the treatment of infections associated with total knee arthroplasty (TKA), and to evaluate the functional outcome and pain in different therapeutic modalities by means of quality of life scores. We evaluat...
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Published in | Acta ortopedica brasileira Vol. 23; no. 5; pp. 239 - 243 |
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Main Authors | , , , , , |
Format | Journal Article |
Language | English |
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Sociedade Brasileira de Ortopedia e Traumatologia
01.10.2015
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Abstract | To identify and compare the rate of success of therapeutic modalities applied in surgeries for the treatment of infections associated with total knee arthroplasty (TKA), and to evaluate the functional outcome and pain in different therapeutic modalities by means of quality of life scores.
We evaluated all patients who developed periprosthetic infection after TKA for primary or secondary osteoarthritis, in the period from January 1(st), 2008 to December 31(st), 2010.
In the study period, 29 patients with TKA had infection, and 12 of these underwent debridement and retention of the prosthesis (D+R), seven received two-stage and six one-stage exchange arthroplasties, and four patients were treated with suppressive antibiotic therapy because they could not undergo another surgical procedure.
The D+R, one-stage revision and two-stage revision success rates were 75%, 83.3%, and 100%, respectively. The best results of quality of life (QoL) and function occur in patients undergoing D+R. In contrast, the worst QoL and functional results were obtained in patients treated with two-stage revision arthroplasty. Level of Evidence II, Prognostic Studies - Investigating the Effect of a Patient Characteristic on the Outcome of Disease. |
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AbstractList | Objectives: To identify and compare the rate of success of therapeutic modalities applied in surgeries for the treatment of infections associated with total knee arthroplasty (TKA), and to evaluate the functional outcome and pain in different therapeutic modalities by means of quality of life scores. Methods: We evaluated all patients who developed periprosthetic infection after TKA for primary or secondary osteoarthritis, in the period from January 1
st
, 2008 to December 31
st
, 2010. Results: In the study period, 29 patients with TKA had infection, and 12 of these underwent debridement and retention of the prosthesis (D+R), seven received two-stage and six one-stage exchange arthroplasties, and four patients were treated with suppressive antibiotic therapy because they could not undergo another surgical procedure. Conclusion: The D+R, one-stage revision and two-stage revision success rates were 75%, 83.3%, and 100%, respectively. The best results of quality of life (QoL) and function occur in patients undergoing D+R. In contrast, the worst QoL and functional results were obtained in patients treated with two-stage revision arthroplasty.
Level of Evidence II, Prognostic Studies - Investigating the Effect of a Patient Characteristic on the Outcome of Disease. To identify and compare the rate of success of therapeutic modalities applied in surgeries for the treatment of infections associated with total knee arthroplasty (TKA), and to evaluate the functional outcome and pain in different therapeutic modalities by means of quality of life scores. We evaluated all patients who developed periprosthetic infection after TKA for primary or secondary osteoarthritis, in the period from January 1(st), 2008 to December 31(st), 2010. In the study period, 29 patients with TKA had infection, and 12 of these underwent debridement and retention of the prosthesis (D+R), seven received two-stage and six one-stage exchange arthroplasties, and four patients were treated with suppressive antibiotic therapy because they could not undergo another surgical procedure. The D+R, one-stage revision and two-stage revision success rates were 75%, 83.3%, and 100%, respectively. The best results of quality of life (QoL) and function occur in patients undergoing D+R. In contrast, the worst QoL and functional results were obtained in patients treated with two-stage revision arthroplasty. Level of Evidence II, Prognostic Studies - Investigating the Effect of a Patient Characteristic on the Outcome of Disease. Objectives:To identify and compare the rate of success of therapeutic modalities applied in surgeries for the treatment of infections associated with total knee arthroplasty (TKA), and to evaluate the functional outcome and pain in different therapeutic modalities by means of quality of life scores.Methods:We evaluated all patients who developed periprosthetic infection after TKA for primary or secondary osteoarthritis, in the period from January 1st, 2008 to December 31st, 2010.Results:In the study period, 29 patients with TKA had infection, and 12 of these underwent debridement and retention of the prosthesis (D+R), seven received two-stage and six one-stage exchange arthroplasties, and four patients were treated with suppressive antibiotic therapy because they could not undergo another surgical procedure.Conclusion:The D+R, one-stage revision and two-stage revision success rates were 75%, 83.3%, and 100%, respectively. The best results of quality of life (QoL) and function occur in patients undergoing D+R. In contrast, the worst QoL and functional results were obtained in patients treated with two-stage revision arthroplasty. Level of Evidence II, Prognostic Studies - Investigating the Effect of a Patient Characteristic on the Outcome of Disease. OBJECTIVESTo identify and compare the rate of success of therapeutic modalities applied in surgeries for the treatment of infections associated with total knee arthroplasty (TKA), and to evaluate the functional outcome and pain in different therapeutic modalities by means of quality of life scores.METHODSWe evaluated all patients who developed periprosthetic infection after TKA for primary or secondary osteoarthritis, in the period from January 1(st), 2008 to December 31(st), 2010.RESULTSIn the study period, 29 patients with TKA had infection, and 12 of these underwent debridement and retention of the prosthesis (D+R), seven received two-stage and six one-stage exchange arthroplasties, and four patients were treated with suppressive antibiotic therapy because they could not undergo another surgical procedure.CONCLUSIONThe D+R, one-stage revision and two-stage revision success rates were 75%, 83.3%, and 100%, respectively. The best results of quality of life (QoL) and function occur in patients undergoing D+R. In contrast, the worst QoL and functional results were obtained in patients treated with two-stage revision arthroplasty. Level of Evidence II, Prognostic Studies - Investigating the Effect of a Patient Characteristic on the Outcome of Disease. |
Author | Klautau, Giselle Burlamaqui Camargo, Osmar Pedro Arbix Salles, Mauro José Costa Cinagawa, Eduardo Hitoshi Tsuge Cury, Ricardo de Paula Leite Honda, Emerson Kiyoshi |
AuthorAffiliation | Faculdade de Ciências Médicas da Santa Casa de São Paulo |
AuthorAffiliation_xml | – name: Faculdade de Ciências Médicas da Santa Casa de São Paulo |
Author_xml | – sequence: 1 givenname: Ricardo de Paula Leite surname: Cury fullname: Cury, Ricardo de Paula Leite organization: Faculdade de Medicina da Santa Casa de Misericórdia de São Paulo (SCMSP), São Paulo, SP, Brazil – sequence: 2 givenname: Eduardo Hitoshi Tsuge surname: Cinagawa fullname: Cinagawa, Eduardo Hitoshi Tsuge organization: Faculdade de Medicina da Santa Casa de Misericórdia de São Paulo (SCMSP), São Paulo, SP, Brazil – sequence: 3 givenname: Osmar Pedro Arbix surname: Camargo fullname: Camargo, Osmar Pedro Arbix organization: Faculdade de Medicina da Santa Casa de Misericórdia de São Paulo (SCMSP), São Paulo, SP, Brazil – sequence: 4 givenname: Emerson Kiyoshi surname: Honda fullname: Honda, Emerson Kiyoshi organization: Faculdade de Medicina da Santa Casa de Misericórdia de São Paulo (SCMSP), São Paulo, SP, Brazil – sequence: 5 givenname: Giselle Burlamaqui surname: Klautau fullname: Klautau, Giselle Burlamaqui organization: Faculdade de Medicina da Santa Casa de Misericórdia de São Paulo (SCMSP), São Paulo, SP, Brazil – sequence: 6 givenname: Mauro José Costa surname: Salles fullname: Salles, Mauro José Costa organization: Faculdade de Medicina da Santa Casa de Misericórdia de São Paulo (SCMSP), São Paulo, SP, Brazil |
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Cites_doi | 10.1086/368182 10.1056/NEJMra040181 10.1093/jac/dkp107 10.1097/01.blo.0000143806.72379.7d 10.5435/00124635-200906000-00004 10.1097/00003086-198401000-00015 10.1097/00003086-200012000-00012 10.1086/322972 10.1056/NEJMcp0905029 10.1111/j.1469-0691.2009.02761.x 10.2106/00004623-200011000-00006 10.1302/0301-620X.86B5.14887 10.1086/499234 10.1007/s11999-009-0945-0 10.1097/00003086-199912000-00014 10.1126/science.284.5418.1318 10.4065/74.6.553 10.1007/s11999-008-0209-4 10.1007/s11999-009-1013-5 10.1016/j.idc.2005.07.010 10.1302/0301-620X.77B2.7706354 10.1016/j.rbo.2012.10.007 |
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Keywords | Infection Prosthesis retention Arthroplasty Prosthesis-related infections Knee prosthesis |
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References_xml | – year: 1996 ident: ref15 contributor: fullname: Kleinbaum DG – volume: 36 start-page: 845 issue: 7 year: 2003 ident: ref26 article-title: Outcome of penicillin-susceptible streptococcal prosthetic joint infection treated with debridement and retention of the prosthesis publication-title: Clin Infect Dis doi: 10.1086/368182 contributor: fullname: Meehan AM – volume: 351 start-page: 1645 issue: 16 year: 2004 ident: ref8 article-title: Prosthetic-joint infections publication-title: N Engl J Med doi: 10.1056/NEJMra040181 contributor: fullname: Zimmerli W – volume: 63 start-page: 1264 issue: 6 year: 2009 ident: ref21 article-title: One hundred and twelve infected arthroplasties treated with 'DAIR' (debridement, antibiotics and implant retention) antibiotic duration and outcome publication-title: J Antimicrob Chemother doi: 10.1093/jac/dkp107 contributor: fullname: Byren I – start-page: 79 issue: 427 year: 2004 ident: ref12 article-title: Practical applications of antibiotic-loaded bone cement for treatment of infected joint replacements publication-title: Clin Orthop Relat Res doi: 10.1097/01.blo.0000143806.72379.7d contributor: fullname: Hanssen AD – volume: 17 start-page: 356 issue: 6 year: 2009 ident: ref13 article-title: Static and mobile antibiotic-impregnated cement spacers for the management of prosthetic joint infection publication-title: J Am Acad Orthop Surg doi: 10.5435/00124635-200906000-00004 contributor: fullname: Jacobs C – volume: 182 start-page: 117 year: 1984 ident: ref22 article-title: Factors influencing the incidence and outcome of infection following total joint arthroplasty publication-title: Clin Orthop Relat Res doi: 10.1097/00003086-198401000-00015 contributor: fullname: Poss R – start-page: 101 issue: 381 year: 2000 ident: ref24 article-title: Limited role of direct exchange arthroplasty in the treatment of infected total hip replacements publication-title: Clin Orthop Relat Res doi: 10.1097/00003086-200012000-00012 contributor: fullname: Jackson WO – volume: 33 start-page: 1387 issue: 8 year: 2001 ident: ref7 article-title: Biofilm formation a clinically relevant microbiological process publication-title: Clin Infect Dis doi: 10.1086/322972 contributor: fullname: Donlan RM – volume: 361 start-page: 787 issue: 8 year: 2009 ident: ref9 article-title: Clinical practice Infection associated with prosthetic joints publication-title: N Engl J Med doi: 10.1056/NEJMcp0905029 contributor: fullname: Del Pozo JL – year: 2006 ident: ref14 contributor: fullname: Kirkwood BR – volume: 15 start-page: 1163 issue: 12 year: 2009 ident: ref11 article-title: Efficacy and tolerance of rifampicin-linezolid compared with rifampicin-cotrimoxazole combinations in prolonged oral therapy for bone and joint infections publication-title: Clin Microbiol Infect doi: 10.1111/j.1469-0691.2009.02761.x contributor: fullname: Nguyen S – volume: 82 start-page: 1552 issue: 11 year: 2000 ident: ref19 article-title: Evaluation of preoperative cultures before second-stage reimplantaion of a total knee prosthesis complicated by infection A comparison-group study publication-title: J Bone Joint Surg Am doi: 10.2106/00004623-200011000-00006 contributor: fullname: Mont MA – volume: 86 start-page: 688 issue: 5 year: 2004 ident: ref2 article-title: Infection after total knee arthroplasty publication-title: J Bone Joint Surg Br doi: 10.1302/0301-620X.86B5.14887 contributor: fullname: Blom AW – volume: 42 start-page: 471 issue: 4 year: 2006 ident: ref10 article-title: Outcome of prosthetic joint infections treated with debridement and retention of components publication-title: Clin Infect Dis doi: 10.1086/499234 contributor: fullname: Marculescu CE – volume: 468 start-page: 45 issue: 1 year: 2009 ident: ref1 article-title: The epidemiology of revision total knee arthroplasty in the United States publication-title: Clin Orthop Relat Res doi: 10.1007/s11999-009-0945-0 contributor: fullname: Bozic KJ – start-page: 139 issue: 369 year: 1999 ident: ref25 article-title: One-stage revision surgery of the infected hip A minimum 10-year followup study publication-title: Clin Orthop Relat Res doi: 10.1097/00003086-199912000-00014 contributor: fullname: Callaghan JJ – volume: 284 start-page: 1318 issue: 5418 year: 1999 ident: ref6 article-title: Bacterial biofilms a common cause of persistent infections publication-title: Science doi: 10.1126/science.284.5418.1318 contributor: fullname: Costerton JW – volume: 74 start-page: 553 issue: 6 year: 1999 ident: ref23 article-title: Staphylococcus aureus prosthetic joint infection treated with prosthesis removal and delayed reimplantation arthroplasty publication-title: Mayo Clin Proc doi: 10.4065/74.6.553 contributor: fullname: Brandt CM – volume: 466 start-page: 1710 issue: 7 year: 2008 ident: ref4 article-title: Periprosthetic joint infection the incidence, timing, and predisposing factors publication-title: Clin Orthop Relat Res doi: 10.1007/s11999-008-0209-4 contributor: fullname: Pulido L – volume: 468 start-page: 52 issue: 1 year: 2010 ident: ref5 article-title: Prosthetic joint infection risk after TKA in the Medicare population publication-title: Clin Orthop Relat Res doi: 10.1007/s11999-009-1013-5 contributor: fullname: Kurtz SM – volume: 19 start-page: 885 issue: 4 year: 2005 ident: ref20 article-title: Prosthetic joint infections publication-title: Infect Dis Clin North Am doi: 10.1016/j.idc.2005.07.010 contributor: fullname: Sia IG – volume: 57 start-page: 305 year: 2008 ident: ref3 article-title: Infected total knee arthroplasty diagnosis and treatment publication-title: Instr Course Lect contributor: fullname: Garvin KL – volume: 77 start-page: 307 issue: 2 year: 1995 ident: ref16 article-title: Recurrence of infection after revision of infected hip arthroplasties publication-title: J Bone Joint Surg Br doi: 10.1302/0301-620X.77B2.7706354 contributor: fullname: Went P – start-page: 55 issue: 321 year: 1995 ident: ref17 article-title: Patient outcome with reinfection following reimplantation for the infected total knee arthroplasty publication-title: Clin Orthop Relat Res contributor: fullname: Hanssen AD – volume: 48 start-page: 432 issue: 5 year: 2013 ident: ref18 article-title: Artroplastia primária de joelho infectada fatores de risco para falha na terapia cirúrgica publication-title: Rev Bras Ortop doi: 10.1016/j.rbo.2012.10.007 contributor: fullname: Pradella JGD – volume: 182 start-page: 117 year: 1984 end-page: 126 article-title: Factors influencing the incidence and outcome of infection following total joint arthroplasty publication-title: Clin Orthop Relat Res – start-page: 101 issue: 381 year: 2000 end-page: 105 article-title: Limited role of direct exchange arthroplasty in the treatment of infected total hip replacements publication-title: Clin Orthop Relat Res – volume: 74 start-page: 553 issue: 6 year: 1999 end-page: 558 article-title: Staphylococcus aureus prosthetic joint infection treated with prosthesis removal and delayed reimplantation arthroplasty publication-title: Mayo Clin Proc – volume: 468 start-page: 45 issue: 1 year: 2009 end-page: 51 article-title: The epidemiology of revision total knee arthroplasty in the United States publication-title: Clin Orthop Relat Res – volume: 77 start-page: 307 issue: 2 year: 1995 end-page: 309 article-title: Recurrence of infection after revision of infected hip arthroplasties publication-title: J Bone Joint Surg Br – volume: 36 start-page: 845 issue: 7 year: 2003 end-page: 849 article-title: Outcome of penicillin-susceptible streptococcal prosthetic joint infection treated with debridement and retention of the prosthesis publication-title: Clin Infect Dis – volume: 82 start-page: 1552 issue: 11 year: 2000 end-page: 1557 article-title: Evaluation of preoperative cultures before second-stage reimplantaion of a total knee prosthesis complicated by infection A comparison-group study publication-title: J Bone Joint Surg Am – volume: 86 start-page: 688 issue: 5 year: 2004 end-page: 691 article-title: Infection after total knee arthroplasty publication-title: J Bone Joint Surg Br – volume: 468 start-page: 52 issue: 1 year: 2010 end-page: 56 article-title: Prosthetic joint infection risk after TKA in the Medicare population publication-title: Clin Orthop Relat Res – volume: 48 start-page: 432 issue: 5 year: 2013 end-page: 437 article-title: Artroplastia primária de joelho infectada fatores de risco para falha na terapia cirúrgica publication-title: Rev Bras Ortop – start-page: 79 issue: 427 year: 2004 end-page: 85 article-title: Practical applications of antibiotic-loaded bone cement for treatment of infected joint replacements publication-title: Clin Orthop Relat Res – volume: 17 start-page: 356 issue: 6 year: 2009 end-page: 368 article-title: Static and mobile antibiotic-impregnated cement spacers for the management of prosthetic joint infection publication-title: J Am Acad Orthop Surg – volume: 351 start-page: 1645 issue: 16 year: 2004 end-page: 1654 article-title: Prosthetic-joint infections publication-title: N Engl J Med – volume: 33 start-page: 1387 issue: 8 year: 2001 end-page: 1392 article-title: Biofilm formation a clinically relevant microbiological process publication-title: Clin Infect Dis – volume: 63 start-page: 1264 issue: 6 year: 2009 end-page: 1271 article-title: One hundred and twelve infected arthroplasties treated with 'DAIR' (debridement, antibiotics and implant retention) antibiotic duration and outcome publication-title: J Antimicrob Chemother – volume: 57 start-page: 305 year: 2008 end-page: 315 article-title: Infected total knee arthroplasty diagnosis and treatment publication-title: Instr Course Lect – start-page: 139 issue: 369 year: 1999 end-page: 143 article-title: One-stage revision surgery of the infected hip A minimum 10-year followup study publication-title: Clin Orthop Relat Res – volume: 466 start-page: 1710 issue: 7 year: 2008 end-page: 1715 article-title: Periprosthetic joint infection the incidence, timing, and predisposing factors publication-title: Clin Orthop Relat Res – year: 1996 publication-title: Survival analysis:a self-learning text contributor: fullname: Kleinbaum, DG – volume: 361 start-page: 787 issue: 8 year: 2009 end-page: 794 article-title: Clinical practice Infection associated with prosthetic joints publication-title: N Engl J Med – volume: 42 start-page: 471 issue: 4 year: 2006 end-page: 478 article-title: Outcome of prosthetic joint infections treated with debridement and retention of components publication-title: Clin Infect Dis – volume: 19 start-page: 885 issue: 4 year: 2005 end-page: 914 article-title: Prosthetic joint infections publication-title: Infect Dis Clin North Am – start-page: 55 issue: 321 year: 1995 end-page: 67 article-title: Patient outcome with reinfection following reimplantation for the infected total knee arthroplasty publication-title: Clin Orthop Relat Res – volume: 15 start-page: 1163 issue: 12 year: 2009 end-page: 1169 article-title: Efficacy and tolerance of rifampicin-linezolid compared with rifampicin-cotrimoxazole combinations in prolonged oral therapy for bone and joint infections publication-title: Clin Microbiol Infect – volume: 284 start-page: 1318 issue: 5418 year: 1999 end-page: 1322 article-title: Bacterial biofilms a common cause of persistent infections publication-title: Science – year: 2006 publication-title: Essential medical statistics contributor: fullname: Kirkwood, BR; Sterne, JA |
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Snippet | To identify and compare the rate of success of therapeutic modalities applied in surgeries for the treatment of infections associated with total knee... OBJECTIVESTo identify and compare the rate of success of therapeutic modalities applied in surgeries for the treatment of infections associated with total knee... Objectives: To identify and compare the rate of success of therapeutic modalities applied in surgeries for the treatment of infections associated with total... Objectives:To identify and compare the rate of success of therapeutic modalities applied in surgeries for the treatment of infections associated with total... |
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StartPage | 239 |
SubjectTerms | Arthroplasty Infection Knee prosthesis Original ORTHOPEDICS Prosthesis retention Prosthesis-related infections |
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Title | TREATMENT OF INFECTION AFTER TOTAL KNEE ARTHROPLASTY |
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