288 / 324
Between 2006 and 2008, 2290 TKP were ana-
lyzed. 44 patients were infected (infection rate
1.9%) but 19 patients were referred. 8 surgical
teams participated in this study.
The diagnosis and management of periprosthe-
tic sepsis was being based on the useful classi-
fication of Tsukayama
and al.
and Segawa
and
al.
[1, 2].
• Type I:
a positive intraoperative culture at
revision without previous evidence of
infection
• Type II:
early postoperative infection (2-
4 weeks) superficial or deep
• Type III:
hematogenous infection
• Type IV:
late chronic infection (longer than
one month)
In our series, there were:
• Type I:
0
• Type II:
9
•
Type III:
3
• Type IV:
32
In our country, the infection declared within a
year after the procedure is considered as a
nosocomial infection. Following this notifica-
tion, 21 out of our 44 patients were declared as
nosocomial.
Antibiotics prophylaxy was Cephalosporin 3 x
1g or 3 x 2g.
The infecting organisms were a
coccus+
in 39
cases (
86%
)
• Cocci Gram+:
Staphylococcus Aureus
: 19
(5 MRSA)
-
Staphylococcus Epidermidis
: 5 (2 MRSE)
-
Streptococcus
: 11
-
Enterococcus
: 4
• Bacillus Gram- : Klebsiella Pneumoniae: 1
- E. Coli: 1
- Enterobacter: 1
• Multiple: 1
• Not specified: 2
MRSA and MRSE
occured in about 15% of
infected knees (2 Oxacilline Resistant
Staphylococcus Epidermidis
!).
The treatment applied was 7 arthroscopic lava-
ge and 19 arthrotomy debridement.
• 7 arthroscopic lavage → 4 needed revision
(1 MRSA, 3
Staphylococcus Aureus
),
• 19 arthrotomy synovectomy (4 with change
of poly) → 4 needed revision (2
Staphylo-
coccus Aureus
, 2
Streptococcus
),
So less than ½ patients → good results with
arthroscopic treatment.
287
ABELGIAN STUDYAND GUIDELINES
FOR AN INFECTED TKP
S. WILLEMS, P. CLAYSON, N. JEKELER, A. HEBRANT
in collaboration with “GROUPE GENOU SORBCOT”