Faculty Collaboration Database

[Results of one-stage endoprosthesis revision in periprosthetic infection cause by methicillin-resistant Staphylococcus aureus]. Z Orthop Ihre Grenzgeb 2000;138(3):240-4

Date

08/10/2000

Pubmed ID

10929616

DOI

10.1055/s-2000-10143

Scopus ID

2-s2.0-0033925620 (requires institutional sign-in at Scopus site)   33 Citations

Abstract

OBJECTIVE: Are the results of one-stage exchange arthroplasties to treat periprosthetic infection caused by methicillin-resistant Staphylococcus aureus (MRSA) comparable to bacteriologically unselected studies of one-stage exchange operations?

METHOD: From 1996 to 1997 twenty patients with a periprosthetic infection caused by methicillin-resistant Staphylococcus aureus (MRSA) were treated at the ENDO-Klinik by an one-stage exchange arthroplasty. Mean follow-up of fifteen one-stage exchange total hip replacements and 5 one-stage exchange total knee replacements was 16 months. The patients were examined by means of clinical, laboratory-chemical and radiological tests. In addition, postoperative joint aspiration was performed on 14 patients.

RESULTS: In 11 cases (61%) the periprosthetic infection was treated successfully with only one one-stage exchange operation. In cases with persisting infection the period between the first exchange arthroplasty and the repeated clinical manifestation of the infection (second exchange operation) was 2 months on average. 93% of the joint aspirations (n = 14), performed on average 4 weeks postoperatively, correlated with the result of the follow-up tests.

CONCLUSION: Periprosthetic infection with MRSA is a problematic infection. Because of the reduced therapeutic possibilities it is associated with a higher rate of recurrence than the unselected group of patients as a whole [6, 11, 16, 17, 19, 20]. The authors recommend one-stage exchange arthroplasty using a combination of vancomycin and ofloxacin as admixture to polymethylmethacrylat (Refobacin Palacos R). This procedure does, however, need further development. Intraoperative use of an antiseptic and systemic administration of rifampicin, as recommended by Zimmerli [23] is a further possibility.

Author List

Kordelle J, Frommelt L, Klüber D, Seemann K

MESH terms used to index this publication - Major topics in bold

Aged
Aged, 80 and over
Bone Cements
Female
Gentamicins
Hip Prosthesis
Humans
Knee Prosthesis
Male
Methicillin Resistance
Methylmethacrylates
Middle Aged
Postoperative Complications
Prosthesis Failure
Prosthesis-Related Infections
Recurrence
Reoperation
Staphylococcal Infections