Background: Two-stage reimplantation is the most accepted mode of
treatment for patients with a periprosthetic infection following total knee
arthroplasty. Most studies, however, do not stratify their results on the
basis of the type of infecting organism. The purpose of this study was to
determine the outcomes for patients who had two-stage reimplantation for the
treatment of infection with a resistant organism, methicillin-resistant
Staphylococcus aureus or methicillin-resistant Staphylococcus
epidermidis, at the site of a total knee replacement.
Methods: A multicenter study was performed to review the cases of
all patients treated between 1987 and 2003 because of an infection with
methicillin-resistant Staphylococcus aureus or methicillin-resistant
Staphylococcus epidermidis organisms at the site of a total knee
replacement. The prevalence of reinfection following two-stage reimplantation
was determined. Variables that may influence the outcome, such as the duration
and type of intravenous antibiotics administered, previous surgery, and
comorbidities of the host, were analyzed.
Results: We identified thirty-seven patients who had an infection
with a resistant organism. All patients had negative cultures at the time of
reimplantation. Four of the thirty-seven patients had a reinfection with the
same organism, while five had a reinfection with a different organism. None of
the variables noted above were found to be significantly associated with
reinfection, on the basis of the numbers available.
Conclusions: Reports in the literature have discouraged
reimplantation for the treatment of an infection with a resistant organism at
the site of a total knee replacement. While 24% of the patients in this series
had a reinfection, 14% had a reinfection with a different organism. We believe
that two-stage reimplantation remains a viable treatment option for patients
who have an infection with a resistant organism at the site of a total knee
Level of Evidence: Therapeutic Level IV. See Instructions
to Authors for a complete description of levels of evidence.