Objective: This study aims to evaluate the impact of the pathogen's sensitivity to the loaded antibiotics on infection resolution, the number of revisions, and the associated costs in patients undergoing revision total knee arthroplasty (rTKA) due to PJI.
Material And Methods: We reviewed the treatment and follow-up processes of 61 patients who underwent rTKA for late-stage PJI following primary total knee arthroplasty in our clinic. The study included 11 patients in the resistant group and 50 in the sensitive group in line with the power analysis results. Patients' demographic characteristics and comorbidities were recorded. All patients received dual antibiotic-loaded cement. Microbiological examinations of patients were analyzed, and the number of revision surgeries each patient underwent was determined. We analyzed all surgeries related to infection treatment, including open irrigation, debridement, polyethylene exchange, implant extractions, antibiotic-loaded cement spacer placements, spacer changes, and debridements, and the implantation of revision prostheses, including tumor prostheses. The total number of surgeries each patient underwent was recorded. We also reviewed hospital system records of total protocol costs during patient admissions.
Results: Of 61 patients undergoing revision total knee arthroplasty (rTKA) for periprosthetic joint infection, 11 had antibiotic-resistant infections and 50 had antibiotic-sensitive infections. The groups had similar demographics. Polymicrobial infections were more frequent in the resistant group (p = 0.017), with all resistant cases showing gentamicin resistance and two showing teicoplanin resistance. The resistant group required more surgeries (average 3.91 ± 2.7 vs. 2.34 ± 1.3, p = 0.043) compared to the sensitive group, with teicoplanin resistance doubling revision surgeries (p = 0.005). Costs were similar between groups, averaging $6536.96. Gram-negative infections led to more revisions (p = 0.013). Polymicrobial infections did not significantly affect the number of surgeries or costs compared to single strain infections.
Conclusions: Our study demonstrates that in rTKA surgeries using dual antibiotic-loaded bone cement, infections caused by antibiotic-resistant microorganisms are more challenging and time-consuming to treat. This underscores the necessity of exploring new methods to enhance local efficacy by loading cement with antibiotics based on specific pathogen culture and sensitivity results, while also providing clinical evidence of the effectiveness of current treatment methods against sensitive microorganisms.
Level Of Evidence: Level 3 (a retrospective cohort study).
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http://dx.doi.org/10.1007/s00590-024-04166-4 | DOI Listing |
Reg Anesth Pain Med
December 2024
Faculty of Medicine, University of Geneva, Geneva, Switzerland
Introduction: Whether a popliteal plexus block improves postoperative pain following total knee arthroplasty remains debated. This randomized trial tested if adding a popliteal plexus block to a continuous femoral nerve block decreases postoperative opioid requirement.
Methods: We included 66 patients undergoing total knee arthroplasty.
Arthroscopy
December 2024
Department of Orthopedic Surgery, University of California San Francisco, San Francisco, CA. Electronic address:
Purpose: To determine if pre-operative infection with COVID-19 increased risk for post-operative venous thromboembolism (VTE) in patients undergoing arthroscopic knee surgery..
Methods: PearlDiver Mariner 165 database was queried for patients undergoing knee arthroscopy between 2010 through October, 2022.
Knee
December 2024
Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, United States.
Background: It remains unknown how timing of preoperative intra-articular knee hyaluronic acid (HA) injections impacts risk for developing postoperative periprosthetic joint infection (PJI) following total knee arthroplasty (TKA).
Methods: The PearlDiver Mariner database was utilized to identified patients undergoing primary TKA between 2015 and 2022 who received an HA injection without a corticosteroid injection within 12 months prior to surgery. The HA cohort was matched 1:1 to a control cohort undergoing no preoperative injections (corticosteroid or HA).
Eur J Orthop Surg Traumatol
December 2024
Department of Orthopaedics and Traumatology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Türkiye.
Objective: This study aims to evaluate the impact of the pathogen's sensitivity to the loaded antibiotics on infection resolution, the number of revisions, and the associated costs in patients undergoing revision total knee arthroplasty (rTKA) due to PJI.
Material And Methods: We reviewed the treatment and follow-up processes of 61 patients who underwent rTKA for late-stage PJI following primary total knee arthroplasty in our clinic. The study included 11 patients in the resistant group and 50 in the sensitive group in line with the power analysis results.
Arch Orthop Trauma Surg
December 2024
Department of General Orthopaedics, Auguste-Viktoria-Clinic Bad Oeynhausen, University Hospital of RUB-Bochum, Am Kokturkanal, 32545, Bad Oeynhausen, Germany.
Introduction: Total lower limb arthroplasties are standard orthopedic surgeries that are steadily increasing in modern civilization. In proportion, the number of revision arthroplasties and the corresponding financial burden for healthcare systems will increase. The present clinical investigation analyzed morbidities after aseptic revision knee arthroplasty.
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