Surgeons should consider pathogen before infected knee debridement
Surgeons who choose debridement for an infected knee implant should also consider pathogen type in their decision-making process, as different methicillin-resistant diseases have various successes with debridement vs. implant removal, according to results of this study.
“In addition to established indications for explantation, such as implant loosening, sinus tract or methicillin resistance, the decision for debridement and retention of knee [periprosthetic joint infections] PJIs should also depend on the pathogen,” the researchers wrote in the abstract. “Implant preservation is futile with methicillin-resistant staphylococci, but seems to be a valid option for streptococcal PJIs.”
Researchers analyzed results from 21 patients who were treated with 1.5 months to 3 months of antibiotics for PJI and then underwent open or arthroscopic debridement. At mean 7-year follow-up, seven patients achieved remission. However, there were no cases of remission in patients with methicillin-resistant Staphylococcus aureus or methicillin-resistant coagulase-negative Staphylococcus, according to the abstract. Remission occurred in 29% of patients with methicillin-sensitive Staphylococcus aureus and in 75% of patients with streptococci.
The researchers also conducted a literature review of 599 knee PJI cases that confirmed their results: implant preservation was successful in 47% of cases, with remission occurring more often in streptococci than staphylococcal cases, according to the abstract.
Disclosure: Orthopedics Today was unable to confirm author disclosures.