Daptomycin for the treatment of gram-positive periprosthetic hip infections: Can daptomycin prevent the implant removal?

Abstract

Background: Management of periprosthetic hip infections (PHIs) generally consists of implant removal and thorough debridement, accompanied by appropriate antibiotic therapy. Daptomycin (DAP) is a novel antibiotic, which allowed for implant retention in several patients after treating their infected joints. However, there is no consensus about implant retention or removal during treatment of PHIs. The aim of this study was to examine the effect of DAP, and to determine a surgical treatment strategy. Methods: This study retrospectively evaluated 20 patients between August 2014 and December 2018, divided into implant retention (n = 9) and implant removal groups (n = 11). Infection control and risk of recurrent infection were evaluated. Infection control was defined as not requiring implant removal after the final treatment. Results: Infection control rates in implant retention and implant removal groups were 67% and 90%, respectively. All late chronic infections resulted in failure cases within the implant retention group. In the implant retention group, mean preoperative risk scores for successful cases were significantly higher than those for failure cases (P < 0.05). Conclusions: Patients with low-risk did not require implant removal, suggesting that DAP may be a breakthrough alternative to traditional PHI management.