Prosthetic joint infections (PJI) after failed knee arthroplasty, especially in complicated courses with persisting or recurrent infections, may result in a considerable destruction of bone substance, the extensor apparatus and the surrounding soft tissue. In these cases reconstruction of a proper knee function may be impossible and the only solutions are: knee arthrodesis or above-the-knee amputation (AKA). However, both methods are associated with considerable functional deficits and high complication rates. The primary aim of the current study is to analyse the clinical course, outcome and complications in patients with knee arthrodesis and AKA after PJI and to compare these two methods in terms of the analysed parameters. Patients treated with a knee arthrodesis or AKA after PJI in an 11-year time period were included in this study. Demographic data, comorbidities, infecting characteristics and operative procedures were recorded. Patients were seen in regular intervals and underwent physical and radiographic examination. Major complications such as: re-infection, implant-failure, revision surgeries or stump healing disorders were recorded. Functional outcome with use of the Lower-Extremity-Functional-Score was assessed and the patients reported general health status (SF-12-questionnaire) was recorded.Aim
Method
To prevent nosocomial transmission (NT) of multiresistent germs (MRG) the German Robert Koch Institute (RKI) recommends to isolate patients with MRG. At a so-called normal ward isolating patients is a challenging and stressful procedure for both patients and hospital staff. The present study proposes the hypothesis that, compared to normal wards, an isolation ward reduces the nosocomial infection rate. After an isolation ward with twelve beds has been established in 2005, patients with MRG on the wards of the department for spinal cord injury as well as on the isolation ward were monitored using a prospective screening and meeting the requirements of the RKI. Apart from detecting transmitter of MRG the NT of these bacteria was identified and registered between 2006 and 2013. The total length of a patients stay in the hospital, the number of isolation days and the rate of NTs were documented. The quotient of MRG load per ward and the number of NTs per ward were compared. In the investigation period of eight years 262175 patient days, 33416 isolation days and 33 transmissions were registered. On the spinal cord injury ward 223167 of the patient days, 1120 of the isolation days and 29 of the NTs were documented. On the isolation ward 39008 of the patient days and 32296 of the isolation days with four of the transmissions were registered. The mean load of MRG resulted from the quotient of the number of days with MRG per 100 patient days. The effective nosocomial frequency of transmission resulted from the quotient of the mean load of MRG to the number of transmissions. As a result, the frequency of transmission on the isolation ward was significantly lower (p=0,001) in comparison to the spinal cord injury ward. The presented results suggest that, despite multiple higher loads of MRG, constructional measures combined with contact isolation facilitate a reduction of NT rates of MRG. The reservation must be made, however, that in case of known MRG the screening was performed under isolation conditions, with unkown MRG without meeting requirements of isolation. The present comparison of NT rates on an isolation ward and a normal spinal cord injury ward emphasizes the importance and function of an isolation ward through constructional (physical) separation and pooling of professional competency for successful management of MRG in healthcare facilities.
