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Pathogen-driven decision for implant retention in the management of infected total knee prostheses

Zürcher-Pfund, Line ; Uçkay, Ilker ; Legout, Laurence ; Gamulin, Axel ; Vaudaux, Pierre ; Peter, Robin

In: International Orthopaedics, 2013, vol. 37, no. 8, p. 1471-1475

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    Titre
    • Pathogen-driven decision for implant retention in the management of infected total knee prostheses
    Auteur
    • Zürcher-Pfund, Line. Orthopedic Surgery Service, Geneva University Hospitals & Faculty of Medicine, University of Geneva, 4, Rue Gabrielle Perret-Gentil, 1211, Geneva 14, Switzerland
    • Uçkay, Ilker. Orthopedic Surgery Service, Geneva University Hospitals & Faculty of Medicine, University of Geneva, 4, Rue Gabrielle Perret-Gentil, 1211, Geneva 14, Switzerland
    • Legout, Laurence. Orthopedic Surgery Service, Geneva University Hospitals & Faculty of Medicine, University of Geneva, 4, Rue Gabrielle Perret-Gentil, 1211, Geneva 14, Switzerland
    • Gamulin, Axel. Orthopedic Surgery Service, Geneva University Hospitals & Faculty of Medicine, University of Geneva, 4, Rue Gabrielle Perret-Gentil, 1211, Geneva 14, Switzerland
    • Vaudaux, Pierre. Service of Infectious Diseases, Geneva University Hospitals & Faculty of Medicine, University of Geneva, 4, Rue Gabrielle Perret-Gentil, 1211, Geneva 14, Switzerland
    • Peter, Robin. Orthopedic Surgery Service, Geneva University Hospitals & Faculty of Medicine, University of Geneva, 4, Rue Gabrielle Perret-Gentil, 1211, Geneva 14, Switzerland
    Type de document
    • Postprint
    Langue
    • Anglais
    Publié dans
    • International Orthopaedics, 2013, vol. 37, no. 8, p. 1471-1475. Springer Berlin Heidelberg
    Autre version électronique
    Classification
    • Santé
    Identifiant OAI-PMH
    • oai:doc.rero.ch:311996
    Summary
    Purpose: In prosthetic joint infections (PJIs) of the knee, debridement with implant retention is associated with a high risk of recurrence. Methods: A single-centre cohort study was performed with extensive analysis of the literature covering 1980-2012. Results: In 21 patients (mean age 80.4years, 19 immunosuppressed), in association with 1.5-threemonths of antibiotic treatment, an attempt was made to salvage the prosthesis by open (11 patients) or arthroscopic (ten patients) debridement. After a mean follow-up of sevenyears (range four-20years), patients were in remission in seven cases (33%). Remission was achieved in 0% of all methicillin-resistant Staphylococcus aureus (MRSA) infections (zero/three), in 0% (zero/three) of methicillin-resistant coagulase-negative staphylococcal infections, in 29% (two/seven) of methicillin-sensitive S. aureus infections and in 75% (three/four) of infections due to streptococci. The literature review focused on implant preserving approaches yielded 599 cases with an overall success rate of 47% (284/599) and significantly more remissions in streptococcal vs staphylococcal knee PJIs (43/54 vs 144/324; p < 0.01, odds ratio 4.9, 95% confidence interval 2.4-10.9). Conclusions: In addition to established indications for explantation such as implant loosening, sinus tract or methicillin resistance, the decision for debridement and retention of knee PJIs should also depend on the pathogen. Implant preservation is futile with methicillin-resistant staphylococci, but seems to be a valid option for streptococcal PJIs