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Staphylococcus aureus Prosthetic Joint Infection Treated With Prosthesis Removal and Delayed Reimplantation Arthroplasty

  • Author Footnotes
    1 Dr Brandt is now with the Institut fuer Medizinische Mikrobiologie der RWTH Aachen, Germany. Dr Berbari is now with the Hotel Dieu de France, Department de Maladies Infectieuses, Beirut, Lebanon.
    Claudia M. Brandt
    Footnotes
    1 Dr Brandt is now with the Institut fuer Medizinische Mikrobiologie der RWTH Aachen, Germany. Dr Berbari is now with the Hotel Dieu de France, Department de Maladies Infectieuses, Beirut, Lebanon.
    Affiliations
    Division of Infectious Diseases and Internal Medicine, Mayo Clinic Rochester, Rochester, Minn
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  • Mary C.T. Duffy
    Affiliations
    Division of Infectious Diseases and Internal Medicine, Mayo Clinic Rochester, Rochester, Minn
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  • Elie F. Berbari
    Affiliations
    Division of Infectious Diseases and Internal Medicine, Mayo Clinic Rochester, Rochester, Minn
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  • Arlen D. Hanssen
    Affiliations
    Department of Orthopedic Surgery, Mayo Clinic Rochester, Rochester, Minn
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  • James M. Steckelberg
    Affiliations
    Division of Infectious Diseases and Internal Medicine, Mayo Clinic Rochester, Rochester, Minn
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  • Douglas R. Osmon
    Correspondence
    Address reprint requests and correspondence to Douglas R. Osmon, MD, Division of Infectious Diseases, Mayo Clinic Rochester, 200 First St SW, Rochester, MN 55905
    Affiliations
    Division of Infectious Diseases and Internal Medicine, Mayo Clinic Rochester, Rochester, Minn
    Search for articles by this author
  • Author Footnotes
    1 Dr Brandt is now with the Institut fuer Medizinische Mikrobiologie der RWTH Aachen, Germany. Dr Berbari is now with the Hotel Dieu de France, Department de Maladies Infectieuses, Beirut, Lebanon.

      Objective

      To estimate in patients with Staphylococcus aureus prosthetic joint infection after total hip arthroplasty (THA) or total knee arthroplasty (TKA) the microorganism-specific cumulative probability of treatment failure after prosthesis removal and delayed reimplantation arthroplasty.

      Patients and Methods

      All patients with S aureus THA or TKA infection, according to a strict case definition, who were treated with prosthesis removal and delayed reimplantation arthroplasty at Mayo Clinic Rochester between 1980 and 1991 were identified. The study group comprised patients who were free of infection at the time of reimplantation arthroplasty. This cohort was followed up until treatment failure, infection with another organism, prosthesis removal, death, or loss to follow-up occurred. The Kaplan-Meier survival method was used to estimate the cumulative probability of treatment failure.

      Results

      Among 120 S aureus prosthetic joint infections treated with prosthesis removal during the study period, 38 episodes (22 THA, 16 TKA) in 36 patients met the study inclusion criteria. After a median of 7.4 years (range, 0.9 year-16.4 years) of follow-up, treatment failure occurred in 1 (2.6 %) of 38 episodes 1.4 years after reimplantation arthroplasty. The 5-year cumulative probability of treatment failure was 2.8% (95% confidence interval, 0%-8.2%).

      Conclusions

      These data suggest that prosthesis removal and delayed reimplantation arthroplasty is an effective treatment to limit the recurrence of S aureus prosthetic joint infection, provided there is no evidence of infection at the time of reimplantation arthroplasty.
      PJI (prosthetic joint infection), PMMA (polymethylmethacrylate), THA (total hip arthroplasty), TKA (total knee arthroplasty)
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