INFECTION AROUND JOINT REPLACEMENTS IN PATIENTS WHO HAVE A RENAL OR LIVER-TRANSPLANTATION

The results of thirty-five joint (hip or knee) replacements in ninetee n patients who Bad an organ transplantation were retrospectively revie wed, The patients received a standard immunosuppressive induction regi men at the time of the transplantation and were maintained on a combin ation of prednisone, azathioprine, and cyclosporine A. All patients re ceived antibiotics perioperatively, but antibiotic-impregnated bone ce ment was not used for any procedure. Six joint replacements, in three patients who were an average of 48.2 years old at the time of the athr oplasty were performed before a renal transplantation. Twenty-four joi nt replacements, in fourteen patients who were an average of 40.9 year s old at the time of the arthroplasty, were performed after an organ t ransplantation, Two patients, who were an average of 53.8 years old at the time of the arthroplasty, each had a joint replacement both befor e and after a liver transplantation (a total of five joint replacement s), The average duration of follow-up from the first joint replacement was 8.8 years (range, one to twenty-three years). The Harris hip scor e or The Hospital for Special Surgery knee score was determined at the time of the latest follow-up examination. An infection developed arou nd the implant in five patients who bad had the joint replacement afte r a transplantation. The average interval from implantation of the pro sthesis until detection of the infection was 3.4 Sears (range, one to six sears), One patient who had a liver transplant was infected with P seudomonas aeruginosa and another one was infected, with Escherichia c oli. One patient who had a renal transplant was infected with Staphylo coccus epidermidis; one, with Enterococcus; and one, with Serratia mar cescens. We found that patients who had a joint replacement after an o rgan transplantation had a very high risk of devastating infection, Th e rate of such infection was 19 per cent (five of twenty-seven joint r eplacements in sixteen patients).