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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

Outcomes of Revision Total Knee Arthroplasty After Methicillin-resistant Staphylococcus aureus Infection

Authors: Dann J. Laudermilch, BS, Catherine J. Fedorka, BA, Alma Heyl, CCRC, Nalini Rao, MD, Richard L. McGough, MD

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

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Abstract

Background

The incidence of infection by methicillin-resistant Staphylococcus aureus (MRSA) in total knee arthroplasty (TKA) is becoming a more frequent concern, as increased morbidity following TKA has been reported for infections by resistant organisms. This study investigates whether MRSA infections are associated with decreased functional scores.

Questions/purposes

We therefore compared the functional scores, operative times, and rates of reinfection of revision TKA following MRSA infection versus other indications for revision.

Methods

We retrospectively reviewed charts of 101 patients (103 knees) who underwent mobile bearing TKA revision from January 2003 to September 2006, with a minimum clinical followup of 2 years in 45 knees (44%). We obtained the following indices: WOMAC, Activities of Daily Living Score (ADLS), SF-36, and Knee Society scores (KSS). Three groups of revisions were compared: MRSA infection (n = 6), non-MRSA infection (n = 9), and aseptic failure (n = 30). The three groups were similar in demographics and comorbidities.

Results

The MRSA (166 minutes) and non-MRSA groups (149 minutes) had longer operative times than the aseptic group (121 minutes). With numbers available, there were no differences in ROM, WOMAC, ADLS, KSS, and SF-36, with MRSA separate or combined with all infections. Infection recurrence between MRSA-infected knees and non-MRSA-infected knees was similar.

Conclusions

While our study was underpowered to detect functional differences between MRSA-infected knees and non-MRSA-infected knees it does add data to the literature. Knees revised for infection have longer operative times and more frequent infection after revision. The reason for increased operative times is unclear.

Level of Evidence

Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
Literature
1.
Al-Nammari SS, Bobak P, Venkatesh R. Methicillin resistant Staphylococcus aureus versus methicillin sensitive Staphylococcus aureus adult haematogenous septic arthritis. Arch Orthop Trauma Surg. 2007;127:537–542.CrossRefPubMed
2.
Barrack RL, Engh G, Rorabeck C, Sawhney J, Woolfrey W. Patient satisfaction and outcome measures after septic versus aseptic revision total knee arthroplasty. J Arthroplasty. 2000;15:990–993.CrossRefPubMed
3.
Classen DC, Evans RS, Pestotnik SL, Horn SD, Menlove RL, Burke JP. The timing of prophylactic administration of antibiotics and the risk of surgical-wound infection. N Engl J Med. 1992;326:281–286.CrossRefPubMed
4.
Deirmengian C, Greenbaum J, Lotke PA, Booth RE Jr, Lonner JH. Limited success with open débridement and retention of components in the treatment of acute Staphylococcus aureus infections after total knee arthroplasty. J Arthroplasty. 2003;18:22–26.CrossRefPubMed
5.
Engemann JJ, Carmeli Y, Cosgrove SE, Fowler VG, Bronstein MZ, Trivette SL, Briggs JP, Sexton DJ, Kaye KS. Adverse clinical and economic outcomes attributable to methicillin resistance among patients with Staphylococcus aureus surgical site infection. Clin Infect Dis. 2003;36:592–598.CrossRefPubMed
6.
Ghanem E, Restrepo C, Joshi A, Hozack W, Sharkey P, Parivizi J. Periprosthetic infection does not preclude good outcome for revision arthroplasty. Clin Orthop Relat Res. 2007;461:54–59.PubMed
7.
Hartman MB, Fehring TK, Jordan L, Norton HJ. Periprosthetic knee sepsis. The role of irrigation and débridement. Clin Orthop Relat Res. 1991;273:113–118.PubMed
8.
Hill C, Flamant R, Mazas F, Evrand J. Prophylactic cefazolin versus placebo in total hip replacement: report of a multicentre double-blind randomised trial. Lancet. 1981;1:795–796.CrossRefPubMed
9.
Hirakawa K, Stulberg BN, Wilde AH, Bauer TW, Secic M. Results of 2-stage reimplantation for infected total knee arthroplasty. J Arthroplasty. 1998;13:22–28.CrossRefPubMed
10.
Insall J, Thompson F, Brause B. Two-stage reimplantation for the salvage of infected total knee arthroplasty. J Bone Joint Surg Am. 1983;65:1087–1098.PubMed
11.
Insall JN, Dorr LD, Scott RD, Scott N. Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res. 1989;248:13–14.PubMed
12.
Ip D, Yam SK, Chen CK. Implications of the changing pattern of bacterial infections following total joint replacement. J Orthop Surg (Hong Kong). 2005;13:125–130.
13.
Irrgang JJ, Snyder-Mackler L, Wainner RS, Fu FH, Harner CD. Development of a patient-reported measure of function of the knee. J Bone Joint Surg Am. 1998; 80:1132–1145.PubMed
14.
Kilgus DJ, Howe DJ, Strang A. Results of periprosthetic hip and knee infections caused by resistant bacteria. Clin Orthop Relat Res. 2002;404:116–124.CrossRefPubMed
15.
Leigh DA, Griggs J, Tighe CM, Powell HD, Church JC, Wise K, Channon G, Curtis LB. Pharmacokinetic study of ceftazidime in bone and serum of patients undergoing hip and knee arthroplasty. J Antimicrob Chemother. 1985;16:637–642.CrossRefPubMed
16.
Mittal Y, Fehring TK, Hanssen A, Marculescu C, Odum SM, Osmon D. Two-stage reimplantation for periprosthetic knee infection involving resistant organisms. J Bone Joint Surg Am. 2007;89:1227–1231.CrossRefPubMed
17.
Morrey B, Westholm F, Schoifet S, Rand J, Bryan R. Long-term results of various treatment options for infected total knee arthroplasty. Clin Orthop Relat Res. 1989;248:120–128.PubMed
18.
Nixon M, Jackson B, Varghese P, Jenkins D, Taylor G. Methicillin-resistant Staphylococcus aureus on orthopaedic wards: incidence, spread, mortality, cost and control. J Bone Joint Surg Br. 2006;88:812–817.CrossRefPubMed
19.
Papagelopoulos PJ, Idusuyi OB, Wallrichs SL, Morrey BF. Long term outcome and survivorship analysis of primary total knee arthroplasty in patients with diabetes mellitus. Clin Orthop Relat Res. 1996;330:124–132.CrossRefPubMed
20.
Parvizi J, Assam K, Ghanem E, Austin MS, Rothman RH. Periprosthetic infection due to resistant staphylococci: serious problems on the horizon. Clin Orthop Relat Res. 2009;467:1732–1739.CrossRefPubMed
21.
Parvizi J, Sullivan TA, Pagnano MW, Trousdale RT, Bolander ME. Total joint arthroplasty in human immunodeficiency virus-positive patients: an alarming rate of early failure. J Arthroplasty. 2003;18:259–264.CrossRefPubMed
22.
Patel A, Calfee RP, Plante M, Fischer SA, Arcand N, Born C. Methicillin-resistant Staphylococcus aureus in orthopaedic surgery. J Bone Joint Surg Br. 2008;90:1401–1406.PubMed
23.
Patel R, Osmon DR, Hanssen AD. The Diagnosis of Prosthetic Joint Infection. Current Techniques and Emerging Technologies. Clin Orthop Relat Res. 2005;437:55–58.CrossRefPubMed
24.
Peersman G, Laskin R, Davis J, Peterson M. Infection in total knee replacement. A retrospective review of 6489 total knee replacements. Clin Orthop Relat Res. 2001;392:15–23.CrossRefPubMed
25.
Raj D, Iyer S, Fergusson CM. Methicillin-resistant Staphylococcus aureus infection following arthroscopy of the knee joint. Ann R Coll Surg Engl. 2006;88:675–676.CrossRefPubMed
26.
Salgado CD, Dash S, Cantey JR, Marculescu CE. Higher risk of failure of methicillin resistant Staphylococcus aureus prosthetic joint infections. Clin Orthop Relat Res. 2007;461:48–53.PubMed
27.
Sankar B, Hopgood P, Bell KM. The role of MRSA screening in joint-replacement surgery. International Orthopaedics (SICOT). 2005;29:160–163.CrossRef
28.
Silva M, Tharani R, Schmalzried TP. Results of direct exchange or débridement of the infected total knee arthroplasty. Clin Orthop Relat Res. 2002;404:125–131.CrossRefPubMed
29.
Tannenbaum DA, Matthews LS, Grady-Benson JC. Infection around joint replacements in patients who have a renal or liver transplantation. J Bone Joint Surg Am. 1997;79:36–43.CrossRefPubMed
30.
Volin SJ, Hinrichs SH, Garvin KL. Two-stage reimplantation of total joint infections: a comparison of resistant and non-resistant organisms. Clin Orthop Relat Res. 2004;427:94–100.CrossRefPubMed
31.
Wang CJ, Huang TW, Wang JW, Chen HS. The often poor clinical outcome of infected total knee arthroplasty. J Arthroplasty. 2002;17:608–614.CrossRefPubMed
32.
Ware JR Jr, Sherbourne CD. The MOS 36-item Short-Form health survey (SF-36): I. Conceptual framework and item selection. Med Care. 1992;30:473–483.CrossRefPubMed
33.
Winiarsky R, Barth P, Lotke P. Total knee arthroplasty in morbidly obese patients. J Bone Joint Surg Am. 1998;80:1770–1774.PubMed
34.
Zimmerli W. Prosthetic-joint-associated infection. Best Prac Res Clin Rheumatol. 2006;20:1045–1063.CrossRef
Metadata
Title
Outcomes of Revision Total Knee Arthroplasty After Methicillin-resistant Staphylococcus aureus Infection
Authors
Dann J. Laudermilch, BS
Catherine J. Fedorka, BA
Alma Heyl, CCRC
Nalini Rao, MD
Richard L. McGough, MD
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/s11999-010-1304-x

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