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What is the rate of reinfection with different and difficult-to-treat bacteria after failed one-stage septic knee exchange?

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Abstract

Purpose

Re-operation after septic failure of a one-stage exchange for prosthetic joint infection (PJI) of the knee is a highly challenging procedure with concerns over residual bone stock, soft tissues, and stability. The associated changes in microbiology in cases of reinfection are still largely unknown.

Methods

A comprehensive analysis was performed of all patients treated at our tertiary institution between 2001 and 2017 who developed reinfection after a one-stage exchange for PJI of the knee. Prerequisites for inclusion were a certain diagnosis of PJI according to the ICM criteria and a minimum follow-up of three years. Data on comorbidities, previous surgical interventions, microbiological findings at the time of the initial one-stage exchange and at the time of reinfection, detection methods, and antibiotic resistance patterns were retrospectively studied.

Results

Sixty-six patients were identified that met the inclusion criteria. Reinfection occurred after a mean time interval of 27.7 months (SD ± 33.9, range 1–165). Ten types of bacteria were found that were not present before the one-stage exchange. The causative pathogen remained identical in 22 patients (33%) and additional microorganisms were detected in ten patients (15%). Half of the reinfections were however due to (a) completely different microorganism(s). A significant increase in the number of PJIs on the basis of high-virulent (23 vs 30, p = 0.017) and difficult-to-treat bacteria (13 vs 24, p = 0.035) was found.

Conclusion

The present study provides a novel insight into the microbiological changes following septic failure after one-stage exchange for PJI of the knee. A higher prevalence of more difficult-to-treat bacteria might increase the complexity of subsequent procedures. Also, a longer follow-up of these patients than previously suggested seems in order.

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Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, HELIOS ENDO-Klinik Hamburg, Holstenstr. 2, 22767, Hamburg, Germany

    Mustafa Akkaya, Iman Godarzi Bakhtiari, Thorsten Gehrke & Mustafa Citak

  2. Division of Orthopaedic Surgery, Hip Unit, Gasthuisberg, University Hospitals Leuven, Leuven, Belgium

    Georges Vles

  3. Institute of Orthopaedic Research and Training, Gasthuisberg, University Hospitals, Leuven, Belgium

    Georges Vles

  4. Department of Orthopaedic Surgery, Southland Teaching Hospital, Invercargill, New Zealand

    Amir Sandiford

  5. Department of Surgery, Ruhr-University Hospital, Bochum, Germany

    Jochen Salber

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  1. Mustafa Akkaya
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  2. Georges Vles
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  4. Amir Sandiford
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  5. Jochen Salber
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  7. Mustafa Citak
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Contributions

All authors satisfy the four ICMJE Criteria as follows: substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; drafting the work or revising it critically for important intellectual content; final approval of the version to be published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. M. Akkaya: writing, editing, analysis. G. Vles: writing, editing. I.G. Bakhtiari: data collection, analysis, statistics. A. Sandiford: proofreading, editing. J. Salber: analysis, statistics, writing, editing. T. Gehrke: supervision, proofreading. M. Citak: supervision, writing, editing, analysis.

Corresponding author

Correspondence to Mustafa Citak.

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Ethical approval was performed and has the following number: WF-030/20.

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Competing interests

M.C. has received funding from W. Link & Co KG outside the submitted work. T.G. has received funding from W. Link & Co KG, Zimmer Biomet Inc., Heraeus, and from Ceramtec Co. outside the submitted work. All other authors declare no competing interests.

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Akkaya, M., Vles, G., Bakhtiari, I.G. et al. What is the rate of reinfection with different and difficult-to-treat bacteria after failed one-stage septic knee exchange?. International Orthopaedics (SICOT) 46, 687–695 (2022). https://doi.org/10.1007/s00264-021-05291-z

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