Two-stage Reimplantation of Total Joint Infections

Abstract

The prevalence of resistant organisms has increased throughout the last decade. In order to determine best treatment strategies, studies on reimplantation must address this population. The purpose of this study is to compare the results of delayed reconstruction for total joint infections caused by methicillin-sensitive and methicillin-resistant organisms. This investigation included 46 patients (21 men, 25 women) with an average age 67 years (range, 36-86 years) who had a two-staged reimplantation after periprosthetic total joint infection. Thirty-seven patients cultured methicillin-sensitive organisms and nine cultured methicillin-resistant organisms. Treatment included resection, aggressive debridement, 6 weeks of parenteral antibiotics, and subsequent debridement and reimplantation. Treatment was considered successful if the patient was disease free at last followup (average 5 years, range 2-10 years). The efficacy of two-stage reconstruction was similar for infections with sensitive and resistant bacteria. Only 3 of 46 patients failed delayed reconstruction requiring further treatment. Failure rates with regards to infections with sensitive bacteria were 5.4% (2 of 37 infections) and resistant bacteria 11.1% (1 of 9 infections), which was not significant. The current study shows clinical success of two-stage reimplantation for patients with methicillin-resistant bacteria complicating total joint arthroplasty.