Contemporary 2-Stage Treatment of Periprosthetic Hip Infection with Evidence-Based Standardized Protocols Yields Excellent Results: Caveats and Recommendations

Wichern, Emily; Zielinski, Matthew R.; Ziemba-Davis, Mary; Meneghini, R. Michael

doi:10.1016/j.arth.2020.05.028

Cited by 13 publications

(5 citation statements)

References 63 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The most common treatment for a chronically infected THA in the United States is a two-stage exchange arthroplasty (Parvizi and Della Valle, 2010). Success following this treatment ranges from 85 % successful in some studies to just over 60 % at the 1-year mark specifically (Wichern et al, 2020;Petis et al, 2019). This variability in success can be multifactorial with many risk factors having an impact on outcomes (Berend et al, 2013;Brown et al, 2018) Some of the reported success or failures, however, can also be due to how we define success and how we report the outcomes.…”

Section: Discussionmentioning

confidence: 99%

Complications in the treatment of periprosthetic joint infection of the hip: when do they occur?

Cuadra

Scarola

et al. 2021

J. Bone Joint Infect.

View full text Add to dashboard Cite

Abstract. Prosthetic joint infection (PJI) is a devastating complication after total hip arthroplasty (THA). The common treatment in the USA is a two-stage exchange which can be associated with significant morbidity and mortality. The purpose of this study was to analyze complications in the treatment course of patients undergoing two-stage exchange for PJI THA and determine when they occur. Methods: We analyzed all patients that underwent two-stage exchange arthroplasty for treatment of PJI after THA from January 2005 to January 2018 at a single institution. Complications were categorized as medical or surgical and divided into interstage and post-reimplantation. Minimum follow-up was 1 year. Success was based on the MusculoSkeletal Infection Society (MSIS) definition. Results: 205 hips (203 patients) underwent first stage of planned two-stage exchange. The median age was 68 (interquartile range (IQR) 18). There were 97 males and 106 females. Overall, 73/205 (38 %) patients had at least one complication during treatment: 13.5 % (25/185) of patients experienced a medical complication and 28.1 % (52/185) a surgical complication; 2.4 % died within 1 year of surgery, and 4.9 % (15/203) had mortality at a median of 2.5 years (IQR 4.9); 27 % of patients had complications during the interstage period, most commonly being recurrence of infection requiring additional surgery (63 %); and 14 % of patients experienced a complication following reimplantation, most commonly persistence or recurrence of infection (59 %). While 92 % of patients that initiated treatment were ultimately reimplanted, only 69 % were infection free at 1 year and required no additional treatment. Conclusions: While two-stage exchanges for PJI in THA have been reported as successful, there are few reports of the complications during the process. In our series, significant numbers of patients experienced complications, often during the interstage period, highlighting the morbidity of this method of treatment.

show abstract

Section: Discussionmentioning

confidence: 99%

Complications in the treatment of periprosthetic joint infection of the hip: when do they occur?

Cuadra

Scarola

et al. 2021

J. Bone Joint Infect.

View full text Add to dashboard Cite

show abstract

“…This is important because one-stage exchange is gaining popularity and there is a concern that the radical debridement associated with this procedure may lead to inferior outcomes when they fail. 8 Our results can be used to counsel patients after a failed onestage exchange and help clinicians make informed decisions about treatment.…”

Section: Discussionmentioning

confidence: 90%

“…[1][2][3][4] Traditionally, two-stage exchange has been considered to be the gold standard for treatment of chronic PJI in TKA with a success rate of between 65% and 95%. [5][6][7][8] However, onestage exchange is gaining popularity with similar success in terms of infection control. 5,[9][10][11][12] It is also associated with less time in hospital, decreased A flowchart showing the patients who underwent repeat septic revision after a failed one-stage exchange for PJI in TKA.…”

Section: Introductionmentioning

confidence: 99%

High revision rates following repeat septic revision after failed one-stage exchange for periprosthetic joint infection in total knee arthroplasty

Neufeld

Liechti

Soto

et al. 2022

The Bone & Joint Journal

View full text Add to dashboard Cite

Aims The outcome of repeat septic revision after a failed one-stage exchange for periprosthetic joint infection (PJI) in total knee arthroplasty (TKA) remains unknown. The aim of this study was to report the infection-free and all-cause revision-free survival of repeat septic revision after a failed one-stage exchange, and to determine whether the Musculoskeletal Infection Society (MSIS) stage is associated with subsequent infection-related failure. Methods We retrospectively reviewed all repeat septic revision TKAs which were undertaken after a failed one-stage exchange between 2004 and 2017. A total of 33 repeat septic revisions (29 one-stage and four two-stage) met the inclusion criteria. The mean follow-up from repeat septic revision was 68.2 months (8.0 months to 16.1 years). The proportion of patients who had a subsequent infection-related failure and all-cause revision was reported and Kaplan-Meier survival for these endpoints was determined. Patients were categorized according to the MSIS staging system, and the association with subsequent infection was analyzed. Results At the most recent follow-up, 17 repeat septic revisions (52%) had a subsequent infection-related failure and the five-year infection-free survival was 59% (95% confidence interval (CI) 39 to 74). A total of 19 underwent a subsequent all-cause revision (58%) and the five-year all-cause revision-free survival was 47% (95% CI 28 to 64). The most common indication for the first subsequent aseptic revision was loosening. The MSIS stage of the host status (p = 0.663) and limb status (p = 1.000) were not significantly associated with subsequent infection-related failure. Conclusion Repeat septic revision after a failed one-stage exchange TKA for PJI is associated with a high rate of subsequent infection-related failure and all-cause revision. Patients should be counselled appropriately to manage expectations. The host and limb status according to the MSIS staging system were not associated with subsequent infection-related failure. Cite this article: Bone Joint J 2022;104-B(3):386–393.

show abstract

“…Another study of 89 patients found a very high attrition rate of those patients undergoing 2-stage exchange for PJI due to a high risk of death (24%) and inability to complete the 2-stage protocol (32%); patients who completed the 2-stage protocol had a reinfection rate of 15% at 4.5 years 62 . Another study evaluating 2-stage treatment for periprosthetic hip infection found a success rate of 95.7% at a mean follow-up of 67 months 63 .…”

Section: Treatmentmentioning

confidence: 99%

What’s New in Musculoskeletal Infection

Fehring

Hewlett

et al. 2021

Journal of Bone and Joint Surgery

View full text Add to dashboard Cite

show abstract

Contemporary 2-Stage Treatment of Periprosthetic Hip Infection with Evidence-Based Standardized Protocols Yields Excellent Results: Caveats and Recommendations

Cited by 13 publications

References 63 publications

Complications in the treatment of periprosthetic joint infection of the hip: when do they occur?

Complications in the treatment of periprosthetic joint infection of the hip: when do they occur?

High revision rates following repeat septic revision after failed one-stage exchange for periprosthetic joint infection in total knee arthroplasty

What’s New in Musculoskeletal Infection

Contact Info

Product

Resources

About