Hip Pelvis.  2014 Dec;26(4):235-242. 10.5371/hp.2014.26.4.235.

Clinical Characteristics of Methicillin-resistant Staphylococcus aureus Infection for Chronic Periprosthetic Hip and Knee Infection

• Ryu DJ
• Kang JS
• Moon KH
• Kim MK
• Kwon DG

• KMID: 1907699
• DOI: http://doi.org/10.5371/hp.2014.26.4.235

Abstract

PURPOSE
Deep infection after hip and knee arthroplasty is a serious complication and is difficult to treat due to its toxicity. The aims of our study were to find out the differences of methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-sensitive Staphylococcus aureus (MSSA) infection after hip and knee arthroplasty focusing on clinical course and laboratory findings.
MATERIALS AND METHODS
We retrospectively reviewed 61 staphylococcal infection cases after hip and knee arthroplasty (MSSA in 25 patients, MRSA in 36 patients). Vital signs, laboratory tests, microbiology and clinical courses were analyzed. The average follow-up period was 3.8 years (range, 2 to 10.1 years).
RESULTS
At initial visit, MRSA group showed significant higher erythrocyte sedimentation rate, C-reactive protein (CRP) and neutrophil percentage. The average duration for the normalization of CRP was longer in MRSA group (MRSA: 36.7+/-25.1 days, MSSA: 24.7+/-13.6 days; P=0.008). The mean interval between staging operation was longer in MRSA group (MRSA: mean 8.7 weeks [range, 6.4 to 21.4 weeks], MSSA: mean 6.8 weeks [range, 6 to 13.1 weeks]; P=0.012). MRSA group (13.9%) revealed higher recurrence rate than MSSA group (4%). Two patients (5.6%) from MRSA group expired by sepsis. One limb amputation (2.7%) was carried out in MRSA group.
CONCLUSION
MRSA infection after arthroplasty showed more toxic serologic parameter and poorer prognosis. Aggressive treatment should be considered for MRSA infection following arthroplasty.

Keyword

Arthroplasty; Infection; Methicillin-resistant Staphylococcus aureus; Antibiotic resistance; Vancomycin

MeSH Terms

Amputation
Arthroplasty
Blood Sedimentation
C-Reactive Protein
Drug Resistance, Microbial
Extremities
Follow-Up Studies
Hip*
Humans
Knee*
Methicillin-Resistant Staphylococcus aureus*
Neutrophils
Prognosis
Recurrence
Retrospective Studies
Sepsis
Staphylococcal Infections
Staphylococcus aureus
Vancomycin
Vital Signs
C-Reactive Protein
Vancomycin

Figure

• 

  Fig. 1 X-ray images of a 62-year-old male who was diagnosed as periprosthetic joint infection of left total hip arthroplasty. (A) Hip anteroposterior X-ray at diagnosis. (B) We removed implants and inserted mobile articulating spacer. Methicillin-sensitive Staphylococcus aureus infection was proved through joint fluid and intraoperative tissue culture. (C) Second stage reimplantation was done at 6 weeks after mobile articulating spacer insertion.

• 

  Fig. 2 X-ray images of a 75-year-old female patient who was diagnosed as periprosthetic joint infection of right total knee arthroplasty. (A) Knee anteroposterior X-ray at diagnosis. (B) We removed all of implants and inserted mobile articulating spacer. Methicillin-resistant Staphylococcus aureus infection was proved through joint fluid culture. (C) Second stage reimplantation was done at 10.3 weeks after mobile articulating spacer insertion.

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