Periprosthetic Joint Infection Increases the Risk of One-Year Mortality

Zmistowski, Benjamin; Karam, Joseph A.; Durinka, Joel B.; Casper, David S.; Parvızı, Javad

doi:10.2106/jbjs.l.00789

Cited by 575 publications

(339 citation statements)

References 50 publications

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“…Treatment failures are not only costly, but also are associated with substantial morbidity and mortality [1,3,6,8,12] Although two-stage exchange arthroplasty remains a commonly used treatment approach, it remains imperfect. Studies have reported success rates approaching 90%, whereas others have reported less successful outcomes [7].…”

Section: Discussionmentioning

confidence: 99%

The Mark Coventry, MD, Award: Oral Antibiotics Reduce Reinfection After Two-Stage Exchange: A Multicenter, Randomized Controlled Trial

Frank

Kayupov

Moric

et al. 2017

Clinical Orthopaedics &Amp; Related Research

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120

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Background Many patients develop recurrent periprosthetic joint infection after two-stage exchange arthroplasty of the hip or knee. One potential but insufficiently tested strategy to decrease the risk of persistent or recurrent infection is to administer additional antibiotics after the second-stage reimplantation. Questions/purposes (1) Does a 3-month course of oral antibiotics decrease the risk of failure secondary to infection after a two-stage exchange? (2) Are there any complications related to the administration of oral antibiotics after a two-stage exchange? (3) In those patients who develop a reinfection, is the infecting organism different from the initial infection? Methods Patients at seven centers randomized to receive 3 months of oral antibiotics or no further antibiotic treatment after operative cultures after the second-stage reimplantation were negative. Adult patients undergoing

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Section: Discussionmentioning

confidence: 99%

The Mark Coventry, MD, Award: Oral Antibiotics Reduce Reinfection After Two-Stage Exchange: A Multicenter, Randomized Controlled Trial

Frank

Kayupov

Moric

et al. 2017

Clinical Orthopaedics &Amp; Related Research

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120

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“…Although there are a variety of reasons for the attrition between stages, one sobering recognition is that the proportion of patients who die after the initial resection arthroplasty is not small 1,23 . This study, specifically designed to evaluate the clinical course of patients in between two stages, demonstrated that almost one-fifth of patients who underwent resection arthroplasty and spacer insertion did not undergo a subsequent reimplantation.…”

Section: Discussionmentioning

confidence: 99%

The Fate of Spacers in the Treatment of Periprosthetic Joint Infection

Gómez

Tan

Manrique

et al. 2015

The Journal of Bone and Joint Surgery

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“…Although most series report an infection control rate of approximately 90% for two-stage exchange arthroplasty, it has been shown that the general risk of patient mortality is increased by PJI and its surgical treatment [44], and a twostage approach might be associated with an even higher mortality risk, at least in THA [3]. Some studies have shown possible advantages of one-stage exchange for the infected TKA in selected patients [14], including the need for only one surgical procedure, shorter hospitalization time, reduced time on antibiotic therapy, reduced overall costs, and improved patient satisfaction [16,29,39,40].…”

Section: Introductionmentioning

confidence: 99%

Can Good Infection Control Be Obtained in One-stage Exchange of the Infected TKA to a Rotating Hinge Design? 10-year Results

Zahár

Kendoff

Klatte

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Prosthetic joint infection (PJI) occurs in 1% to 2% of total knee arthroplasties (TKAs). Although two-stage exchange is the preferred management method of patients with chronic PJI in TKA in North America, one-stage exchange is an alternative treatment method, but long-term studies of this approach have not been conducted. Questions/purposes We reviewed our minimum 9-year results of 70 patients who underwent one-stage exchange arthroplasty with a rotating hinge design to determine: (1) What was the proportion of patients free of infection? (2) What was the patient rate of survival free of any reoperation? (3) What were the clinical outcomes as measured by Hospital for Special Surgery scores? (4) What proportion of patients developed radiographic evidence of loosening? Methods All one-stage revision TKAs for infection between January 1 and December 31, 2002, with a minimum 9-year followup (mean, 10 years; range, 9-11 years), in which patients had been seen within the last 1 year, were included in this retrospective review. During that period, 11 patients with infected TKAs were treated with other approaches (including two-stage approaches in eight); the general indication for one-stage revision was the diagnosis of PJI with a known causative organism. Exclusion criteria were culture-negative preoperative aspiration, known allergy to local antibiotics or bone cement, or cases in which radical débridement was impossible as a result of the involvement of important anatomical structures. Eightyone patients with PJI were seen during this period; 70 underwent one-stage exchange using our strict protocol and were reimplanted with a rotating hinge TKA. Eleven patients (15.7%) were lost to followup. Hospital for Special Surgery scores were recorded and all radiographs were evaluated for prosthetic loosening. Failure was defined as revision surgery for infection or any other cause. Results Our 10-year infection-free survival was 93% (mean, 4.1; 95% confidence interval [CI], 89%-96%; p\0.007); and the patient 10-year survival rate free of revision for other causes was 91% (mean, 5.2; 95% CI, 86%-95%; p\0.002). Mean Hospital for Special Surgery knee score at last followup was 69.6 (± 22.5 SD; range, 22-100) and the mean improvement in Hospital for Special Surgery knee score from preoperative to most recent followup was 35 (± 24.2 SD; range, 13-99). Evidence of radiographic loosening was seen in 11 patients at last followup, whereby in six patients, there was need for revision surgery.Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and board members are on file with the publication and can be viewed on request. Clinical Orthopaedics and Related Research 1 neith...

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Periprosthetic Joint Infection Increases the Risk of One-Year Mortality

Cited by 575 publications

References 50 publications

The Mark Coventry, MD, Award: Oral Antibiotics Reduce Reinfection After Two-Stage Exchange: A Multicenter, Randomized Controlled Trial

The Mark Coventry, MD, Award: Oral Antibiotics Reduce Reinfection After Two-Stage Exchange: A Multicenter, Randomized Controlled Trial

The Fate of Spacers in the Treatment of Periprosthetic Joint Infection

Can Good Infection Control Be Obtained in One-stage Exchange of the Infected TKA to a Rotating Hinge Design? 10-year Results

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