2019 ISAKOS Biennial Congress ePoster #955
The Infected Total Knee Arthroplasty: Causative Pathogens and the Outcome of Surgical Revision Strategies
Sven Edward Putnis, MB ChB FRCS(Tr&Orth), Bristol, Somerset UNITED KINGDOM
Thomas Neri, MD, PhD, Prof., Saint-Etienne FRANCE
Brendan Bott, BResEc, MActPrac, Sydney, NSW AUSTRALIA
William Ridley, BMed, MS, Ryde, New South Wales AUSTRALIA
Bernard Hudson, MBBS, Sydney, NSW AUSTRALIA
Myles R. J. Coolican, FRACS, Sydney, NSW AUSTRALIA
Sydney Orthopaedic Research Institute, Sydney, NSW, AUSTRALIA
FDA Status Cleared
Summary
Periprosthetic joint infection (PJI) following a total knee arthroplasty (TKA) is a severe complication causing a significant burden on both the patient and healthcare system. This paper reviews data on PJI to identify the pathogens and the surgical strategies used to eradicate them.
Abstract
Introduction
Peri-prosthetic joint infection (PJI) following a total knee arthroplasty (TKA) is a severe complication causing a significant burden on both the patient and healthcare system. This paper reviews data on PJI to identify the pathogens and the surgical strategies used to eradicate them.
Methods
All patients with a histopathological specimen taken from their TKA during the time period December 2001 to March 2018 at five hospital sites in the Northern Sydney area were matched with revision procedures for infection stored in the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR). This resulted in 303 PJI in TKA undergoing revision procedures in 290 patients.
Results
The mean patient age at time of PJI was 69 +/- 11 years. In 186 cases (61%) an organism was identified, with Staphylococcus (46%), Streptococcus (19%), and Enterococcus (7%) the most common. A further 19 different organisms were identified as causative pathogens, with 6 rare individual cases. There was a significant increase in the number of PJIs during the study period (p<0.05). Surgical management varied; 145 (48%) underwent a Debridement Antibiotics & Implant Retention (DAIR) procedure of which 72% did not have further surgery, 102 underwent single-stage revisions (with no further surgery in 71.5%), and 56 had two-stage revision procedures (with no further unplanned surgery in 86%). Overall 38 cases (12.5%) required =3 revisions (21 failed DAIR, 9 failed one-stage, and 8 failed two-stage).
Discussion And Conclusion
The results confirm the most common causative pathogens and also introduce a number of rarely seen organisms. In this geographical area there has been an increase in the number of infected PJI in TKA which cannot be explained by an increase in number of patients alone. A two-stage revision procedure was the most successful treatment for PJI in avoiding further surgery.