Clinical Orthopaedics and Related Research: August 2010 - Volume 468 - Issue 8 - p 2060–2066 doi: 10.1007/s11999-010-1296-6 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?

Kurd, Mark, F., MD1; Ghanem, Elie, MD1; Steinbrecher, Jill, BS1; Parvizi, Javad, MD, FRCS1, a

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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