Re: Risk Factors for Infection After Knee Arthroplasty

[Guest guest]

I admit patients to rehab quite frequently after knee replacement. I advise

anyone considering a joint replacement to be tested for MRSA

(methicillin-resistant staph aureus). This is a very serious infection that can

lead to the need for removal of the joint replacement parts.

The test just involves a nasal swab. If it is positive, prophylactic antibiotics

can be administered to prevent complications. This simple test and pre-treatment

can lower the risk of prosthetic failure.

(RN) mom to Rob 19 JAS

Risk Factors for Infection After Knee Arthroplasty

*JRA List < >

> Risk Factors for Infection After Knee Arthroplasty

> A Register-Based Analysis of 43,149 Cases

> http://www.ejbjs.org/cgi/content/abstract/91/1/38

>

> The Journal of Bone and Joint Surgery (American). 2009;91:38-47.

>

> Esa Jamsen, BM1, Heini Huhtala, MSc2, Timo Puolakka, MD, PhD1

> and Teemu

> Moilanen, MD, PhD1

> 1 a, Hospital for Joint Replacement, P.O. Box 652, FIN-33101

> Tampere,

> Finland. E-mail address for E. Jamsen: esa.jamsen@...

>

> 2 Tampere School of Public Health, University of Tampere, FIN-

> 33014 Tampere,

> Finland

> Investigation performed at a, Hospital for Joint Replacement,

> Tampere,

> Finland

>

> Background: Clinical studies have revealed a number of important

> risk

> factors for postoperative infection following total knee

> arthroplasty.

> Because of the small numbers of cases in those studies, there is

> a risk of

> obtaining false-negative results in statistical analyses. The

> purpose of the

> present study was to determine the risk factors for infection

> following

> primary and revision knee replacement in a large register-based

> series.

> Methods: A total of 43,149 primary and revision knee

> arthroplasties,

> registered in the Finnish Arthroplasty Register, were followed

> for a median

> of three years. The Finnish Arthroplasty Register and the

> Finnish Hospital

> Discharge Register were searched for surgical interventions that

> were

> performed for the treatment of deep postoperative infections.

> regression

> analysis with any reoperation performed for the treatment of

> infection as

> the end point was performed to determine the risk factors for

> this adverse

> outcome.

>

> Results: Three hundred and eighty-seven reoperations were

> performed because

> of infection. Both partial and complete revision total knee

> arthroplasty

> increased the risk of infection as compared with the risk

> following primary

> knee replacement.

>

> Male patients, patients with seropositive rheumatoid arthritis

> or with a

> previous fracture around the knee, and patients with constrained

> and hinged

> prostheses had increased rates of infection after primary

> arthroplasty.

> Wound-related complications increased the risk of deep infection.

>

> The rate of septic failure was lower after unicondylar than

> after total

> condylar primary knee arthroplasty, but the difference was not

> significant.

> The combination of parenteral antibiotic prophylaxis and

> prosthetic fixation

> with antibiotic-impregnated cement protected against septic

> failure,

> especially after revision knee arthroplasty.

>

> Following revision total knee arthroplasty, diagnosis and

> prosthesis type

> had no effect, but previous revision for the treatment of

> infection and

> wound-healing problems predisposed to repeat revision for the

> treatment of

> infection.

>

> Conclusions: There was an increased risk of deep postoperative

> infection in

> male patients and in patients with rheumatoid arthritis or a

> fracture around

> the knee as the underlying diagnosis for knee replacement.

>

> The results of the present study suggest that the infection rate

> is similar

> after partial revision and complete revision total knee

> arthroplasties.

> Combining intravenous antibiotic prophylaxis with antibiotic-

> impregnated

> cement seems advisable in revision arthroplasty.

>

> Level of Evidence: Prognostic Level II. See Instructions to

> Authors for a

> complete description of levels of evidence.

>

>