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Clinical Orthopaedics and Related Research®
Published in: Clinical Orthopaedics and Related Research® 8/2010

01-08-2010 | Symposium: Papers Presented at the 2009 Meeting of the Musculoskeletal Infection Society

Two-stage Exchange Knee Arthroplasty: Does Resistance of the Infecting Organism Influence the Outcome?

Authors: Mark F. Kurd, MD, Elie Ghanem, MD, Jill Steinbrecher, BS, Javad Parvizi, MD, FRCS

Published in: Clinical Orthopaedics and Related Research® | Issue 8/2010

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Abstract

Background

Periprosthetic joint infection after TKA is a challenging complication. Two-stage exchange arthroplasty is the accepted standard of care, but reported failure rates are increasing. It has been suggested this is due to the increased prevalence of methicillin-resistant infections.

Questions/purposes

We asked the following questions: (1) What is the reinfection rate after two-stage exchange arthroplasty? (2) Which risk factors predict failure? (3) Which variables are associated with acquiring a resistant organism periprosthetic joint infection?

Methods

This was a case-control study of 102 patients with infected TKA who underwent a two-stage exchange arthroplasty. Ninety-six patients were followed for a minimum of 2 years (mean, 34.5 months; range, 24–90.1 months). Cases were defined as failures of two-stage exchange arthroplasty.

Results

Two-stage exchange arthroplasty was successful in controlling the infection in 70 patients (73%). Patients who failed two-stage exchange arthroplasty were 3.37 times more likely to have been originally infected with a methicillin-resistant organism. Older age, higher body mass index, and history of thyroid disease were predisposing factors to infection with a methicillin-resistant organism.

Conclusions

Innovative interventions are needed to improve the effectiveness of two-stage exchange arthroplasty for TKA infection with a methicillin-resistant organism as current treatment protocols may not be adequate for control of these virulent pathogens.

Level of Evidence

Level IV, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
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Metadata
Title
Two-stage Exchange Knee Arthroplasty: Does Resistance of the Infecting Organism Influence the Outcome?
Authors
Mark F. Kurd, MD
Elie Ghanem, MD
Jill Steinbrecher, BS
Javad Parvizi, MD, FRCS
Publication date
01-08-2010
Publisher
Springer-Verlag
Published in
Clinical Orthopaedics and Related Research® / Issue 8/2010
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI
https://doi.org/10.1007/s11999-010-1296-6

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