Is two-stage reimplantation effective for virulent pathogenic infection in a periprosthetic hip? A retrospective analysis

Yoon, Young Wook; Lakhotia, Devendra; Oh, Jong Keon; Moon, Jun Gyu; Prashant, Kumar; Shon, Won Yong

doi:10.5312/wjo.v6.i9.712

Cited by 7 publications

(6 citation statements)

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“…Despite all sterilization conditions and antibiotic prophylaxis, PIJ is seen, even though rarely, and it continues to be the most fearful nightmare of orthopedic surgeons (Zmistowski et al ., ; Tikhilov et al ., ; Yoon et al ., ). Debridement and breaking are performed if PJI occurs in the early period; however, if it is seen late, all the implants are removed and concurrent or two‐stage revision surgery is performed (Tikhilov et al ., ; Yoon et al ., ). However, despite all these treatments, reinfection rates may become 25% after revision surgeries.…”

Section: Discussionmentioning

confidence: 97%

“…The reason for this is that the active microorganism is unknown and the biofilm layer, which is a formed cause the bacteria to become resistant to treatment. Classical method in PJI treatment is two‐stage revision surgery (Yoon et al ., ). However, even this method can be unsuccessful if the agent is unknown or if a suitable antibiotic treatment is not given.…”

Section: Introductionmentioning

confidence: 97%

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N‐acetylcysteine eradicates Pseudomonas aeruginosa biofilms in bone cement

et al. 2016

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Biofilm is an example of bacterial group behavior. We investigated the effect of N-acetylcysteine (NAC) alone and in combination with ciprofloxacin on Pseudomonas aeruginosa biofilm formation. Four groups (each contains six molds) of standardized bone cement molds were infected. NAC, ciprofloxacin each alone, and NAC/ciprofloxacin combination were evaluated in point of inhibiting and eradicating biofilm capacity using microbiological and electron microscopical evaluation techniques. Microbial counts and electron microscopical observations showed that the effect of NAC and ciprofloxacin combination on biofilm formation in bone cement is valuable. NAC enhances the beneficial effect of ciprofloxacin when used in combination with it in bone cement. SCANNING 38:766-770, 2016. © 2016 Wiley Periodicals, Inc.

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Section: Discussionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 97%

N‐acetylcysteine eradicates Pseudomonas aeruginosa biofilms in bone cement

et al. 2016

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“…Unfortunately, there is no international gold standard for the treatment of PJI. Recent studies have compared the outcomes of two‐stage revision surgery for implant replacement versus single‐stage procedures [31, 42, 56]. However, there are no definitive guidelines for these procedures [26, 56].…”

Section: Introductionmentioning

confidence: 99%

“…Recent studies have compared the outcomes of two‐stage revision surgery for implant replacement versus single‐stage procedures [31, 42, 56]. However, there are no definitive guidelines for these procedures [26, 56]. While two‐stage exchange is considered appropriate for chronic difficult‐to‐treat cases, single‐stage exchange has to comply with specific patient‐related criteria [55].…”

Section: Introductionmentioning

confidence: 99%

Salvage procedure for chronic periprosthetic knee infection: the application of DAIR results in better remission rates and infection-free survivorship when used with topical degradable calcium-based antibiotics

Gramlich

Johnson

Kemmerer

et al. 2019

Knee Surg Sports Traumatol Arthrosc

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Purpose Debridement, systemic antibiotics and implant retention (DAIR) is very successful for early periprosthetic joint infection (PJI), but can fail in late-onset cases. We selected patients with PJI who were unsuitable for two-stage exchange total knee arthroplasty (TKA) and compared the outcomes of DAIR with or without degradable calcium-based antibiotics. Methods All patients fulfilled the criteria for late-onset PJI of TKA, as defined by an International Consensus Meeting in 2013, but were unsuitable for multistage procedures and TKA exchange due to operative risk. Fifty-six patients (mean age: 70.6 years, SD ± 10.8), in two historical collectives, were treated using a single-stage algorithm consisting of DAIR without antibiotics (control group, n = 33, 2012-2014), or by DAIR following the implantation of degradable antibiotics as indicated by an antibiogram (intervention group, n = 23, 2014-2017). OSTEOSET ® (admixed vancomycin/tobramycin), and HERA-FILL-gentamicin ® were used as carrier systems. The primary endpoint was re-infection or surgical intervention after DAIR. Results There were no significant differences between the two groups in terms of mean age, Charlson comorbidity index or the rate of mixed infections. Overall, 65.2% of patients achieved remission in the intervention group compared with only 18.2% in the control group (p < 0.001); 50% of re-infections in the intervention group even occurred after 36 months. Kaplan-Meier analysis showed that, compared with controls, the intervention group experienced significantly longer 3-year infection-free survival. Conclusion DAIR shows poor efficacy in difficult-to-treat cases, as demonstrated in our control group, which had a reinfection rate of 81.8%. In contrast, a DAIR group receiving topical calcium-based antibiotics showed significantly higher 3-year infection-free survival. Therefore, the combination of DAIR and degradable antibiogram-based local antibiotics is a reasonable salvage procedure for this body of patients. This is important as the number of severely sick patients who are too old for appropriate PJI treatment is estimated to increase significantly due to demographic change.

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“…Staphylococcus aureus is one of the common causes of infections that occur in surgical shunt operations because the active microorganism is unknown, and the biofilm layer causes the bacteria to become resistant to treatment. Two-stage revision surgery is the classical method in Staphylococcus aureus treatment (30). However, in the case of an unknown agent or the absence of suitable antibiotic treatment, this method can also be unsuccessful.…”

mentioning

confidence: 99%