Temporary new implant spacers increase post-reimplantation total knee prosthesis survival after periprosthetic joint inf
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KNEE
Temporary new implant spacers increase post‑reimplantation total knee prosthesis survival after periprosthetic joint infection Colin Y. L. Woon1 · Joseph Nguyen2 · Milan Kapadia3 · Celeste A. Russell3 · Michael Henry3 · Andy Miller3 · Geoffrey Westrich1 Received: 24 April 2020 / Accepted: 6 October 2020 © European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2020
Abstract Purpose Two-stage exchange arthroplasty is considered the gold standard for treatment of periprosthetic joint infection (PJI) following total knee arthroplasty (TKA). Antibiotic cement spacers can include cement-based spacers (CBS), new components (NEW), and autoclaved components (ACL). The factors that most influence post-reimplantation prosthesis (PRP) survival were determined. Methods A retrospective database review of patients undergoing two-stage exchange arthroplasty from 2008 to 2014 was performed. There were 85 patients, 25 patients and 30 patients in CBS, NEW and ACL groups, respectively. Patient, disease and surgical characteristics were collected and analyzed. Post-reimplantation prosthesis (PRP) survival was modeled using the Kaplan–Meier method. Cox proportional hazard modeling was then performed to identify risk factors associated with implant failure. Results Overall PRP survival was 82% in 140 unilateral TKAs. PRP survival between groups was 81%, 96% and 73% within the minimum 2-year follow-up period, respectively. There was a difference in median interval-to-reimplantation between groups (CBS, 72.0 days; NEW, 111.0 days; ACL, 84.0 days, p = 0.003). Adjusting for time-to-reimplantation, NEW spacers demonstrated greater PRP survival compared with ACL spacers (p = 0.044), and a trend towards greater survival compared with CBS spacers (p = 0.086). Excluding early failures ( 3 vs ≤ 3 cases and > 10 vs ≤ 10 cases). There was also no difference in survival between less experienced vs more experienced surgeons (> 14 years vs ≤ 14 years).
Microbiology The infectious organisms are detailed in Table 2. There was no difference in PRP survival between patients with or without Gram-positive infections (Staph spp., Staph aureus, or MRSA), or polymicrobial infections. Of the six patients with polymicrobial infections, responsible organisms include Group B Strep, MRSA, VRE, P. acnes, MSSA and Enterococcus sp. Patients in this subgroup were treated with new components
Table 2 Infectious organism Organism Gram-positive cocci
No. patients Staph aureus Coagulase Negative Staphylococcus
Streptococcus
Enterococcus Gram-negative rods
Gram-positive rods
Escherichia coli Pseudomonas aeruginosa Enterobacter Serratia Bacteroides Klebsiella Propionibacterium acnes Corynebacterium Arcanobacterium
Negative culture Other
MSSA MRSA Staphylococcus epidermidis Staphylococcus lugdunensis Not otherwise specified Staphylococcus hominis Staphylococcus capitis Streptococcus group B Streptococcus viridans group Peptostreptococcus Streptococcus group A Streptococcus group G Enterococcus VRE
Diphtheroid Corynebacterium Corynebact
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