269. ARTHROPLASTY AFTER SEPTIC ARTHRITIS: 70 CASES

Abstract

Purpose of the study: The purpose of this work was to analyse the results of infection in patients with joint prostheses implanted after septic arthritis, distinguishing evolving versus cured arthritis.

Material and methods: This was a retrospective series of 70 cases of septic arthritis (in 69 patients) including 7 patients with mycobacterial infections and 63 patients with ordinary germ infections. For the seven mycro-bacterial infections (five Mycobacterium tuberculosis and two Mycobacterium xenopi), the arthroplasty was implanted on evolving arthritis and in two on arthritis considered cured. For the 63 cases of common germs (70% staphylococcal infections), the septic arthritis was considered evolving in 36 and cured in 27. For half of the cases, the arthritis was blood-borne and localised in the knee. For cases considered evolving, the arthroplasty was generally a two-phase procedure (32/36 cases). Adapted antibiotics were associated for 93 days on average (45–180). For arthritis considered cured, the arthroplasty was implanted on average 53 months (range 6–700) after the infectious episode, generally in a one-phase procedure (22/27). Adapted antibiotics were associated for 80 days on average in seven patients because of positive intraoperative samples. One patient was lost to follow-up before two years and all others were reviewed with at least two years follow-up (mean 5 years, range 2–13 years).

Results: For the seven cases of mycobacterial arthritis, one patient was lost to follow-up, six had no signs of infection at mean 7 years follow-up. For the other cases, 89% of patients who had a prosthesis for evolving arthritis were considered as cured, 6% relapsed before 18 months and 6% presented a new infection with a different germ. For arthroplasty after assumed cured arthritis, 81% of patients were considered cured, 15% relapsed before 18 months and 4% presented a new infection with another germ.

Discussion: Arthroplasty is the treatment of choice for septic evolving septic arthritis, enabling cure in more than 80%, irrespective of the causal germ, and whether cure of the infection was apparently achieved or not.