Pathogen-driven decision for implant retention in the management of infected total knee prostheses.
Int Orthop
; 37(8): 1471-5, 2013 Aug.
Article
em En
| MEDLINE
| ID: mdl-23695880
PURPOSE: In prosthetic joint infections (PJIs) of the knee, debridement with implant retention is associated with a high risk of recurrence. METHODS: A single-centre cohort study was performed with extensive analysis of the literature covering 1980-2012. RESULTS: In 21 patients (mean age 80.4 years, 19 immunosuppressed), in association with 1.5-three months of antibiotic treatment, an attempt was made to salvage the prosthesis by open (11 patients) or arthroscopic (ten patients) debridement. After a mean follow-up of seven years (range four-20 years), patients were in remission in seven cases (33 %). Remission was achieved in 0 % of all methicillin-resistant Staphylococcus aureus (MRSA) infections (zero/three), in 0 % (zero/three) of methicillin-resistant coagulase-negative staphylococcal infections, in 29 % (two/seven) of methicillin-sensitive S. aureus infections and in 75 % (three/four) of infections due to streptococci. The literature review focused on implant preserving approaches yielded 599 cases with an overall success rate of 47 % (284/599) and significantly more remissions in streptococcal vs staphylococcal knee PJIs (43/54 vs 144/324; p < 0.01, odds ratio 4.9, 95 % confidence interval 2.4-10.9). CONCLUSIONS: In addition to established indications for explantation such as implant loosening, sinus tract or methicillin resistance, the decision for debridement and retention of knee PJIs should also depend on the pathogen. Implant preservation is futile with methicillin-resistant staphylococci, but seems to be a valid option for streptococcal PJIs.
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Infecções Estafilocócicas
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Infecções Estreptocócicas
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Infecções Relacionadas à Prótese
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Artroplastia do Joelho
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Prótese do Joelho
Tipo de estudo:
Diagnostic_studies
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Etiology_studies
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Incidence_studies
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Limite:
Aged80
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Female
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Humans
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Male
Idioma:
En
Revista:
Int Orthop
Ano de publicação:
2013
Tipo de documento:
Article
País de afiliação:
Suíça