Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Nov 18, 2021; 12(11): 842-849
Published online Nov 18, 2021. doi: 10.5312/wjo.v12.i11.842
Risk of methicillin-resistant staphylococcus aureus prosthetic joint infection in elective total hip and knee arthroplasty following eradication therapy
Benjamin Pal Kapur, Xenia Tonge, Gunasekaran Kumar
Benjamin Pal Kapur, Xenia Tonge, Gunasekaran Kumar, Trauma and Orthopaedics, Royal Liverpool University Teaching Hospitals, Liverpool L7 8XP, Merseyside, United Kingdom
Author contributions: Kapur BP, Tonge X and Kumar G contributed equally to this work.
Institutional review board statement: No ethics approval was required for this retrospective review. This study was registered with the hospitals audit department.
Conflict-of-interest statement: The authors have no relevant financial or non-financial interests to disclose.
Data sharing statement: Data is available if requested from the corresponding author at benjaminkapur@nhs.net.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Benjamin Pal Kapur, FRCS, MBChB, Surgeon, Trauma and Orthopaedics, Royal Liverpool University Teaching Hospitals, Prescott Street, Liverpool L7 8XP, Merseyside, United Kingdom. benjaminkapur@nhs.net
Received: May 12, 2021
Peer-review started: May 12, 2021
First decision: July 28, 2021
Revised: August 8, 2021
Accepted: September 29, 2021
Article in press: September 29, 2021
Published online: November 18, 2021
Processing time: 187 Days and 14.1 Hours
Abstract
BACKGROUND

Prosthetic joint infection (PJI) is a devastating complication requiring prolonged treatment and multiple operations, leading to significant morbidity for the patient. Patients are routinely tested for methicillin-resistant staphylococcus aureus (MRSA) colonisation. MRSA positive patients are given eradication therapy. We hypothesise that patients who are MRSA positive pre-operatively, have increased risk of developing PJI.

AIM

To identify deep wound infection (PJI) rates in patients who are colonised MRSA positive compared with those who are not colonised; and long term clinical and radiological outcomes.

METHODS

All patients who underwent total hip and knee replacements (THR/TKR) between December 2009 and December 2019 were identified. Patients who were also identified as being MRSA positive at pre-operative assessment were then selected. Confirmation of prescribing eradication treatment was recorded. Patient records, including consultation letters, operation notes and microbiology results were reviewed retrospectively. Comparison of outcomes for each MRSA positive patient was made with 2 MRSA negative patients undergoing the same operation of a similar age by the same consultant.

RESULTS

Screening identified 42 knee and 32 hip arthroplasty patients as MRSA positive, 84 MRSA negative knee and 64 hip patients were reviewed. Patients were matched with medical co-morbidities in each group. Mean follow up was 5 years. PJI was identified in 4/32 (12.5%) of THR MRSA positive and 3/42 (7%) of TKR patients. All patients had PJI within one year of surgery.

CONCLUSION

MRSA positive patients are given eradication therapy routinely. However, no confirmation of eradication is sought. Patients who have MRSA colonisation pre-operatively, in our study had a significantly increased risk of PJI, when compared to negative patients. We would recommend establishing true eradication after treatment prior to arthroplasty.

Keywords: Hip; Knee; Prosthetic joint infection

Core Tip: Retesting to ascertain true eradication of methicillin-resistant staphylococcus aureus (MRSA) prior to arthroplasty is essential. Without this, eradication treatment success remains undetermined with the resultant increased incidence of MRSA prosthetic joint infection and associated morbidity and mortality with revision surgery.