title: Limited success with open debridement and retention of components in the treatment of acute Staphylococcus aureus infections after total knee arthroplasty.
abstract: The purpose of this study was to review our experience in treating acute gram-positive infections after total knee arthroplasty with debridement, component retention, and intravenous antibiotics. Thirty-one total knee arthroplasties with acute gram-positive infections, seen at our institution over a 10-year period, were treated with open debridement and component retention. Eleven (35%) of 31 patients successfully retained their components at most recent follow-up, without ongoing infection (mean, 4 years; range, 2-10 years). Only one (8%) of the 13 patients infected with Staphylococcus aureus was successfully treated, compared with 10 (56%) of 18 patients with either Staphylococcus epidermidis or a streptococcal species. The difference between these groups is statistically significant (P=.007). The high failure rate of debridement and component retention suggests that immediate component removal should be considered in the presence of acute S. aureus infection in total knee arthroplasty.
authors.affiliation: University of Pennsylvania School of Medicine, Department of Orthopaedic Surgery, Philadelphia, USA.
authors.forename: Carl
authors.initials: C
authors.lastname: Deirmengian
authors.forename: Jordan
authors.initials: J
authors.lastname: Greenbaum
authors.forename: Paul A
authors.initials: PA
authors.lastname: Lotke
authors.forename: Robert E
authors.initials: RE
authors.lastname: Booth
authors.forename: Jess H
authors.initials: JH
authors.lastname: Lonner
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee; D003646:Debridement; D005260:Female; D006801:Humans; D007720:Knee Prosthesis / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000601:surgery*; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000601:surgery*; D013212:Staphylococcus epidermidis; D016896:Treatment Outcome