One-Stage Exchange Arthroplasty for Chronic Periprosthetic Hip Infection: Results of a Large Prospective Cohort Study

Zeller, Valérie; Lhotellier, Luc; Marmor, Simon; Leclerc, Philippe; Krain, Alysa; Graff, Wilfrid; Ducroquet, F.; Biau, David; Léonard, Philippe; Desplaces, Nicole; Mamoudy, P.

doi:10.2106/jbjs.l.01451

Cited by 106 publications

(55 citation statements)

References 30 publications

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“…In all patients undergoing empirical therapy, antibiotics were streamlined as soon as the susceptibility testing was available. In patients with staphylococcal infection, the mean time between surgery and administration of rifampin was 8 days (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). In six patients, evacuation of fluid retention was required during index hospitalisation, namely, 12-24 days after surgery.…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

One-stage revision of infected hip arthroplasty: outcome of 39 consecutive hips

Ilchmann

Zimmerli

Ochsner

et al. 2015

International Orthopaedics (SICOT)

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Section: Resultsmentioning

confidence: 99%

“…For PJI, uncemented reimplantations are performed in two-stage exchanges [11,12]. However, successful one-stage exchange with the use of uncemented implants has also been described [13][14][15]. At our hospital, an algorithm to stratify patients with established PJI to the most appropriate management was developed in the 1990s.…”

Section: Introductionmentioning

confidence: 99%

One-stage revision of infected hip arthroplasty: outcome of 39 consecutive hips

Ilchmann

Zimmerli

Ochsner

et al. 2015

International Orthopaedics (SICOT)

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“…However, uncemented stems are still rarely used in 1-stage exchange (Zeller et al. 2014, Ilchmann et al. 2016), and there are no data on detailed radiological outcome.…”

mentioning

confidence: 99%

Eradication of infection, survival, and radiological results of uncemented revision stems in infected total hip arthroplasties

Born¹,

Ilchmann

Zimmerli

et al. 2016

Acta Orthopaedica

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Background and purpose — The use of uncemented revision stems is an established option in 2-stage procedures in patients with periprosthetic joint infection (PJI) after total hip arthroplasty (THA). However, in 1-stage procedures, they are still rarely used. There are still no detailed data on radiological outcome after uncemented 1-stage revisions. We assessed (1) the clinical outcome, including reoperation due to persistent infection and any other reoperation, and (2) the radiological outcome after 1- and 2-stage revision, using an uncemented stem.Patients and methods — Between January 1993 and December 2012, an uncemented revision stem was used in 81 THAs revised for PJI. Patients were treated with 1- or 2-stage procedures according to a well-defined algorithm (1-stage: n = 28; 2-stage: n = 53). All hips had a clinical and radiological follow-up. Outcome parameters were eradication of infection, re-revision of the stem, and radiological changes. Survival was calculated using Kaplan-Meier analysis. Radiographs were analyzed for bone restoration and signs of loosening. The mean clinical follow-up time was 7 (2–15) years.Results — The 7-year infection-free survival was 96% (95% CI: 92–100), 100% for 1-stage revision and 94% for 2-stage revision (95% CI: 87–100) (p = 0.2). The 7-year survival for aseptic loosening of the stem was 97% (95% CI: 93–100), 97% for 1-stage revision (95% CI: 90–100) and 97% for 2-stage revision (95% CI: 92–100) (p = 0.3). No further infection or aseptic loosening occurred later than 7 years postoperatively. The radiographic results were similar for 1- and 2-stage procedures.Interpretation — Surgical management of PJI with stratification to 1- or 2-stage exchange according to a well-defined algorithm combined with antibiotic treatment allows the safe use of uncemented revision stems. Eradication of infection can be achieved in most cases, and medium- and long-term results appear to be comparable to those for revisions for aseptic loosening.

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“…The presence of appropriate antibiotics may be adequate to prevent the establishment of a microbial biofilm on the PICC even in the presence of persistent bacteraemia. This may be analogous to the situation in prosthetic joint infection revision surgery where single‐stage revisions, with a new prosthesis being implanted into a potentially non‐sterile site, still lead to the cure of infection in 90–95% of cases at 5 years . Similarly, central venous access is often required for community‐onset septic shock requiring ICU admission; when blood cultures taken at admission subsequently become positive, it does not routinely indicate a line change.…”

Section: Discussionmentioning

confidence: 99%

Early use of peripherally inserted central catheters is safe in Staphylococcus aureus bacteraemia

Stewart

Runnegar

2018

Internal Medicine Journal

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Background Management of Staphylococcus aureus bacteraemia (SAB) includes prolonged intravenous antibiotics often administered through a peripherally inserted central catheter (PICC). Optimal timing of PICC insertion for SAB treatment is unknown. There are concerns that early insertion may increase the risk of subsequent line infection. Aims This retrospective audit aims to determine if early PICC insertion is safe. The outcomes considered included crude mortality, attributable mortality, PICC line infections, duration of bacteraemia and relapsed SAB. Methods Patients with SAB at our institution between March 2013 and September 2016 were identified. Early PICC line insertion was defined as occurring within 48 h of index positive blood culture. Results This retrospective audit identified 357 patients with SAB who subsequently received a PICC. This study did not show any significant differences between the early and late PICC insertion groups for attributable mortality (6.3% and 4.8%, P = 0.27), duration of bacteraemia (median 2 days for both groups, P = 0.48) and relapsed SAB (4.7% and 4.1%, P = 0.74). Importantly, no confirmed PICC infections were identified in either group. Conclusions Early PICC insertion in SAB appears safe in this retrospective audit. If validated in prospective studies, this should allow for the early establishment of safe, reliable intraveous access in SAB patients.

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One-Stage Exchange Arthroplasty for Chronic Periprosthetic Hip Infection: Results of a Large Prospective Cohort Study

Cited by 106 publications

References 30 publications

One-stage revision of infected hip arthroplasty: outcome of 39 consecutive hips

One-stage revision of infected hip arthroplasty: outcome of 39 consecutive hips

Eradication of infection, survival, and radiological results of uncemented revision stems in infected total hip arthroplasties

Early use of peripherally inserted central catheters is safe in Staphylococcus aureus bacteraemia

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