High incidence of early periprosthetic joint infection following total hip arthroplasty with concomitant or previous hardware removal

Scholten, Ruben; Füssenich, Wout; Somford, Matthijs P.; Susante, Job L C van

doi:10.1007/s00402-019-03149-z

Cited by 14 publications

(17 citation statements)

References 16 publications

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“…This rate appears to be high for THA, especially considering an early PJI rate of 5.8%. Nevertheless, the data are in line with the current literature, and several studies even reported clearly higher numbers with a PJI risk ranging from 1.3 to 18% [ 13 , 21 , 39 – 41 ]. Several reasons might influence the increased infection risk and include the prolonged operation time [ 42 ], scar tissue in the approach for hip exposure, synovitis and hip stiffness and higher risk for intraoperative fractures due to osteopenia [ 16 ].…”

Section: Discussionsupporting

confidence: 91%

Single-stage total hip arthroplasty after failed fixation of proximal femoral fractures: an increased risk for periprosthetic joint infections?

Hemmann

Schmidutz

Ahrend

et al. 2021

Arch Orthop Trauma Surg

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Background Higher complication rates have been reported for total hip arthroplasty (THA) after osteosynthesis of proximal femur fractures (PFF). This study evaluated the infection risk for conversion of internal fixation of PFF to THA by a single-staged procedure in the absence of clear infection signs. Methods Patients undergoing a one-staged conversion to THA (2013–2018) after prior internal fixation of the proximal femur were included. Preoperative diagnostics with laboratory results, hip aspirations as well as intraoperative microbiology and sonication were assessed. Postoperative complications were recorded as well as patient demographics, duration between initial and conversion to THA, explanted osteosynthesis and implanted THA. Results Fifty-eight patients (24 male/34 female, 62.8 ± 14.5 years) were included with a mean time of 3.8 ± 7.5 years between internal fixation and conversion to THA (45 cementless, 3 cemented, 3 hybrid and 7 hybrid inverse THAs). Preoperative mean blood level CRP was 8.36 ± 14 mg/l (reference value < 5 mg/l) and leukocyte count was 7.11 ± 1.84^3/µl (4.5–10.000^3/µl). Fifty patients had intraoperative microbiological diagnostics, with either swabs in 86.2% and/or sonication in 29.3%. Positive microbiological results were recorded in 10% (5 of 50 patients), with pathogens identified being mainly Staphylococcus. Complications after conversion occurred in 9.6% including a postoperative low-grade infection rate of 5.8% after a mean of 2.5 years. Conclusion This study found a positive microbiological test result in 10% of a one-stage conversion of PFF fixation to THA. Moreover, we found a high infection rate (5.8%) for early postoperative periprosthetic joint infection. Interestingly, CRP has not been proven to be an adequate parameter for low-grade infections or occult colonized implants. Therefore, we recommend a comprehensive pre- and intraoperative diagnostic including hip aspiration, swabs and sonication when considering one-staged revision.

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Section: Discussionsupporting

confidence: 91%

Single-stage total hip arthroplasty after failed fixation of proximal femoral fractures: an increased risk for periprosthetic joint infections?

Hemmann

Schmidutz

Ahrend

et al. 2021

Arch Orthop Trauma Surg

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“…A previous study compared the rate of early PJI after conversion THA between patients undergoing single-stage or two-stage surgery, but without taking into account preoperative signs of infection or other patient-specific factors. 27 This study had shown a significantly higher rate of PJI in patients treated with a single-stage surgery and therefore generally recommended a two-stage procedure. 27 In this current study, both patients that developed PJI had elevated CRP values preoperatively and both underwent conversion THA due to early fixation failure.…”

Section: Discussionmentioning

confidence: 79%

“… 27 This study had shown a significantly higher rate of PJI in patients treated with a single-stage surgery and therefore generally recommended a two-stage procedure. 27 In this current study, both patients that developed PJI had elevated CRP values preoperatively and both underwent conversion THA due to early fixation failure. These results are in keeping with a previous study that reported CRP to be a useful screening tool to identify patients that are at an increased risk of PJI after conversion THA.…”

Section: Discussionmentioning

confidence: 79%

Is implant sonication useful when screening for infection in conversion of prior hip fracture fixation to total hip arthroplasty?

et al. 2021

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Objective To examine sonication results in presumed aseptic conversion total hip arthroplasty (THA) after hip fracture fixation and to evaluate its implications on the treatment outcome. Methods This retrospective cohort study reviewed the data from presumed aseptic patients that underwent conversion of prior internal fixation of proximal femoral fractures to THA between 2012 and 2018. Microbiological analysis was performed using sonication of osteosynthesis material and tissue samples. Treatment outcome including the occurrence of periprosthetic joint infection (PJI) was recorded. Results A total of 32 patients were included in the study. Of these, five patients (15.6%) had positive intraoperative cultures. The mean follow-up following conversion THA was 43.0 months (range, 19.0–91.5 months). Sonication was positive in three patients (9.4%), all of whom were deemed contaminated and did not develop PJI. Tissue cultures were positive in two patients (6.3%). One patient with Enterococcus faecalis received antibiotic treatment and did not develop PJI. Another patient with growth of Cutibacterium acnes that was initially classified as a contaminant later developed acute PJI caused by the same pathogen. Overall, PJI occurred in two patients (6.3%) after conversion THA. Conclusion Sonication of internal fixation devices did not add diagnostic value in clinically aseptic conversion THA. Further studies are needed to better understand the relevance of unexpected positive cultures, and to develop diagnostic criteria for the management of these patients.

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“…cTHA with concomitant hardware removal may be a complex procedure with possible orthopedic and non-orthopedic complications, considering more similarities to revision THA in demographic, clinical, preoperative and early postoperative characteristics compared to primary THA [ 3 , 4 ]. The indications to perform cTHA concomitant to hardware removal are still debated [ 5 ]; single-stage cTHA has been demonstrated to be a viable and safe procedure [ 6 ], but some authors consider this surgery a risk factor for periprosthetic joint infections (PJI) due to the possible bacterial colonization of the hardware [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

“…To our knowledge, only a few studies [ 5 ] have directly investigated septic complications rate following single-stage cTHA, and no clear guidelines or recommendations concerning infection screening prior to cTHA in patients with hardware in situ are available [ 8 ]. Remarkably, the last consensus meeting in 2018 did not provide a univocal answer concerning this topic [ 9 , 10 ] nor evidence to change perioperative antibiotic prophylaxis [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Clinical Outcomes and Complication Rate after Single-Stage Hardware Removal and Total Hip Arthroplasty: A Matched-Pair Controlled Study

Camera

Matteo

Maio

et al. 2023

JCM

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Background: Single-stage hardware removal and total hip arthroplasty is a complex surgical procedure, comparable to revision surgery. The purpose of the current study is to evaluate single-stage hardware removal and THA outcomes, compare this technique with a matched control group that has undergone primary THA and assess the risk of periprosthetic joint infection with a 24-month minimum follow-up. Methods: This study included all those cases treated with THA and concomitant hardware removal from 2008 to 2018. The control group was selected on a 1:1 ratio among patients who underwent THA for primary OA. The Harris Hip (HHS) and University of California at Los Angeles Activity (UCLA) scores, infection rate and early and delayed surgical complications were recorded. Results: One hundred and twenty-three consecutive patients (127 hips) were included, and the same number of patients was assigned to the control group. The final functional scores were comparable between the two groups; a longer operative time and transfusion rate were recorded in the study group. Finally, an increased incidence of overall complications was reported (13.8% versus 2.4%), but no cases of early or delayed infection were found. Conclusions: Single-stage hardware removal and THA is a safe and effective but technically demanding technique, with a higher incidence of overall complications, making it more similar to revision THA than to primary THA.

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High incidence of early periprosthetic joint infection following total hip arthroplasty with concomitant or previous hardware removal

Cited by 14 publications

References 16 publications

Single-stage total hip arthroplasty after failed fixation of proximal femoral fractures: an increased risk for periprosthetic joint infections?

Single-stage total hip arthroplasty after failed fixation of proximal femoral fractures: an increased risk for periprosthetic joint infections?

Is implant sonication useful when screening for infection in conversion of prior hip fracture fixation to total hip arthroplasty?

Clinical Outcomes and Complication Rate after Single-Stage Hardware Removal and Total Hip Arthroplasty: A Matched-Pair Controlled Study

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