title: Reinfection after prior staged reimplantation for septic total knee arthroplasty: is salvage still possible?
abstract: Although results of staged reimplantation for septic total knee arthroplasty (TKA) are well-known, the outcomes of a subsequent repeat infection are not well studied. We studied 34 patients (35 TKA), who were treated for reinfection after prior staged reimplantation for septic TKA. Successful outcome was defined an infection-free prosthetic joint at the time of the last follow-up or death. At a mean follow-up of 59.2 (24-168) months, success was achieved in 24 (68.6%) of 35 knees. Among the failures were 5 amputations, 2 arthrodeses, 1 resection arthroplasty, and 3 continued antibiotic cement spacers. Failure was significantly (P = .02) related to growth of resistant microorganisms. Success was achieved significantly more often (P = .002) with complete prosthetic removal and reimplantation rather than debridement and retention of component(s). Reinfection after prior reimplantation for septic TKA is challenging but success is possible, although less frequent as compared to first time infection after a primary TKA.
authors.affiliation: Department of Orthopedics, University of Minnesota Medical Center, R200, 2450 Riverside Ave S, Minneapolis, Minnesota 55454, USA.
authors.forename: Aditya V
authors.initials: AV
authors.lastname: Maheshwari
authors.forename: Terence J
authors.initials: TJ
authors.lastname: Gioe
authors.forename: Niraj V
authors.initials: NV
authors.lastname: Kalore
authors.forename: Edward Y
authors.initials: EY
authors.lastname: Cheng
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D019645:Arthroplasty, Replacement, Knee; D003646:Debridement; D020878:Device Removal; D005260:Female; D005500:Follow-Up Studies; D006621:Hip Joint / Q000000981:diagnostic imaging / Q000382:microbiology / Q000502:physiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D007720:Knee Prosthesis / Q000382:microbiology*; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000517:prevention & control / Q000628:therapy*; D011859:Radiography; D012008:Recurrence; D012086:Reoperation; D012092:Replantation; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods*; D013203:Staphylococcal Infections / Q000517:prevention & control / Q000628:therapy*; D013210:Staphylococcus / Q000302:isolation & purification; D016896:Treatment Outcome