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J Knee Surg 2024; 37(12): 834-842
DOI: 10.1055/a-2337-2402
Original Article

The Microbiology of Knee Prosthetic Joint Infection and its Influence on Persistent Infection

Sven E. Putnis
1   Sydney Orthopaedic Research Institute, Chatswood, Sydney, Australia
2   Trauma & Orthopaedic Department, Bristol Royal Infirmary, University Hospitals Bristol & Weston NHS Foundation Trust, Bristol, United Kingdom
3   Avon Orthopaedic Centre, Bristol, United Kingdom
,
Antonio Klasan 
1   Sydney Orthopaedic Research Institute, Chatswood, Sydney, Australia
4   Trauma & Orthopaedic Department, AUVA UKH Hospitals Steiermark, Graz, Austria
5   Johannes Kepler University, Linz, Austria
,
Brendan Bott
1   Sydney Orthopaedic Research Institute, Chatswood, Sydney, Australia
,
William Ridley
1   Sydney Orthopaedic Research Institute, Chatswood, Sydney, Australia
,
Bernard Hudson
6   Department of Microbiology & Infectious Diseases, Royal North Shore Hospital, Sydney, Australia
,
Myles R.J. Coolican
1   Sydney Orthopaedic Research Institute, Chatswood, Sydney, Australia
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Abstract

Periprosthetic joint infection (PJI) following total knee arthroplasty (TKA) is a severe complication causing a significant burden. The study aims were to establish the epidemiology of microorganisms in TKA PJI, the rate of persistent infection requiring further surgery, and the risk factors for this. Microbiological specimens between June 2002 and March 2017 at five regional hospital sites were identified with revision TKA procedures in the National Joint Replacement Registry. The time between procedures, type of revision strategy, and any subsequent further revision operations were collected. At minimum 2-year follow-up, 174 revision TKA were identified, with a mean patient age of 69 ± 11 years. A broad range of pathogens were identified. Fifty cases (29%) had persistent infection requiring at least one further operative procedure, 13 cases required 3 or more. Coagulase-negative Staphylococcus species (CNS) was seen most with failed surgery, polymicrobial infections also posing a significant risk factor. The best chance of a successful PJI surgical strategy was < 12 months from primary TKA, with the greatest risk between 3 and 5 years (p < 0.05). Younger age significantly increased the risk of further surgery (p < 0.05). Management varied; 103 (59%) debridement, antibiotic therapy and implant retention, with further surgery in 29%; 45 (17%) single-stage revision, with further surgery in 13%; and 26 (15%) two-stage revision, with further surgery in 12%. This study presents the most common causative pathogens for PJI in TKA, and the high rate of persistent infection after initial revision surgery. Risk factors for persistent infection and further revision surgery were polymicrobial and CNS infections, patients who presented between 3 and 5 years following primary TKA, and younger age. This study therefore raises important risk factors and areas for future research to reduce the burden of multiple operations after PJI.

Keywords

prosthetic joint infection - infected - total knee arthroplasty - revision total knee arthroplasty - microorganisms - unplanned revision - age

Note

Research carried out at Sydney Orthopaedic Research Institute.




Publication History

Received: 20 September 2023

Accepted: 22 May 2024

Accepted Manuscript online:
03 June 2024

Article published online:
26 June 2024

© 2024. Thieme. All rights reserved.

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