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Guideline [Infected knee arthroplasty. A treatment algorithm at the Kantonsspital Liestal, Switzerland] 2006
Maurer TB, Ochsner PE. · Interdisziplinäre Einheit Orthopädie - Infektiologie, Orthopädische Klinik, Kantonsspital, Rheinstrasse 26, CH-4410, Liestal. · Orthopade. · Pubmed #16835763 No free full text.
Abstract: The algorithm differentiates between several surgical treatment options depending on the duration of the infection, on the amount of soft tissue damage, on the stability of the implant and the type of micro-organism. If the symptoms of infection exist for less then 3 weeks, a radical debridement is indicated under the condition of a stable implant and good soft tissue conditions. A one-stage exchange is possible with satisfactory conditions of soft tissue and the absence of difficult-to-treat, resistant micro-organisms. In patients with sinustracts or compromised soft tissue, a two-stage exchange is necessary. The placement of a spacer combined with a short interval of 2-3 weeks until reimplantation is possible for easy-to-treat bacteria. For difficult-to-treat micro-organisms, an interval of 8 weeks without spacer until reimplantation is necessary. While stabilised by a fixateur extern, antimicrobial treatment is administered for the first 6 weeks. If the tissue specimens at reimplantation two weeks later do not show growth of bacteria or signs of acute inflammation, antimicrobial treatment can be discontinued. For all other above-mentioned treatment protocols, we administer antimicrobial treatment for a total of 6 months. We present the results of 40 consecutive infected total knee arthroplasties treated according to our algorithm, including a detailed presentation of the two-stage revision procedure.
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Article Statistical analysis of failure times in total joint replacement. 2001
Schwarzer G, Schumacher M, Maurer TB, Ochsner PE. · Freiburg Centre for Data Analysis and Modelling, University of Freiburg, Freiburg, Germany. · J Clin Epidemiol. · Pubmed #11576810 No free full text.
Abstract: Time to revision is an important criterion describing the quality of implants in total joint surgery. Estimates of failure probabilities are required to inform a patient about the risk of suffering a reoperation. Also, regression models are used for comparing different prosthesis designs. Typically, patients dying before a revision are considered as censored for time to prosthesis failure. We argue that this technique is inadequate for estimation of failure probabilities and insufficient for comparison of different designs. We propose a new approach based on a competing risk model to account for concurrent mortality. We describe differences in the estimation of failure probabilities and in the interpretation of regression models for implant failure. Additionally, we introduce a random effects term in the regression model to account for potential dependencies in the failure times of bilaterally treated patients. The new approach is illustrated with fictitious data and data from an observational study conducted at a specialized hospital in Switzerland.
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