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CC BY-NC-ND 4.0 · Revista Chilena de Ortopedia y Traumatología 2022; 63(02): e87-e92
DOI: 10.1055/s-0042-1750697
Artículo Original | Original Article

Periprosthetic Infections in Total Knee Arthroplasty: What Is Our Reality?

Article in several languages: español | English
Alex Vaisman
1   Departamento de Ortopedia y Traumatología, Hospital Padre Hurtado y Clínica Alemana, Santiago, Chile
,
Juan Pablo Casas-Cordero
1   Departamento de Ortopedia y Traumatología, Hospital Padre Hurtado y Clínica Alemana, Santiago, Chile
,
Sebastián Bianchi
1   Departamento de Ortopedia y Traumatología, Hospital Padre Hurtado y Clínica Alemana, Santiago, Chile
,
Diego Edwards
1   Departamento de Ortopedia y Traumatología, Hospital Padre Hurtado y Clínica Alemana, Santiago, Chile
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Abstract

Introduction Periprosthetic infection (PPI) is one of the most serious complications in total knee arthroplasty (TKA). Despite this, there is little Chilean literature regarding this pathology.

Objectives To determine the incidence, comorbidities, isolated microorganisms and their antibiotic susceptibility, morbidity, and mortality in patients with PPI.

Materials and Methods A descriptive and retrospective study in patients operated between 2001 and 2020 for gonarthrosis, with a primary TKA, in the same health center, with at least 1 year of follow-up. Patients operated on in other centers or with incomplete clinical records were excluded. Comorbidities, isolated microorganisms, antibiotic susceptibility, and survival were recorded through a systematic search of the clinical records of patients with PPI. Descriptive statistics were used to present the data.

Results We included 544 TKAs, 8 (1.47%) of which presented PPI, and the patients had an average age at presentation of 66 years (±5.7 years) and an average body mass index (BMI) of 30.3 (±4, 5) kg/m2. The median time of presentation of the PPI was of 411 (±1,034) days. The main comorbidities recorded were arterial hypertension in 5 (62.5%), smoking in 4 (50%) cases, and dyslipidemia in 4 (50%) cases. In total, 5 (62.5%) patients presented polymicrobial etiology, and in 3 (37.5%), a single microorganism was isolated. The main isolated agents were Staphylococcus aureus and coagulase-negative Staphylococcus, both multidrug-resistant, in 6 (75%) and 3 (37.5%) patients respectively. All patients received three doses of cefazolin as surgical prophylaxis. A sensitivity of 100% to vancomycin and rifampicin (12/12 cultures), and a resistance of 83.4% to ciprofloxacin (4/9 cultures) were described. Overall, 2 (25%) patients died 3 years after the TKA, due to causes unrelated to PPI. There were no cases of infectious relapse after the review.

Conclusion An incidence of 1.47% (8 cases) of PPI was found. All patients with PPI presented some presurgical comorbidity. The main microbiological agents identified were multidrug-resistant and susceptible to vancomycin and rifampicin.

Keywords

periprosthetic infection - knee - microorganisms - antibiotic resistance


Publication History

Received: 01 December 2021

Accepted: 17 May 2022

Article published online:
03 October 2022

© 2022. Sociedad Chilena de Ortopedia y Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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