Periprothetische Früh- und Spätinfektionen

Lehner, Burkhard; Omlor, Georg; Schwarze, Martin

doi:10.1007/s00132-020-03950-4

Cited by 4 publications

(4 citation statements)

References 75 publications

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“…Some have suggested that a prior failed I + D procedure may reduce the chance of a later successful two-stage implantation resulting in a 34% failure rate, but this has been refuted in more recent US studies [ 42 , 65 , 66 , 67 , 68 ]. In our series, most patients had multiple debridements in association with NPWTI, as dictated by the presence of residual infection and outlined in the treatment protocol described by Lehner et al [ 9 , 69 ].…”

Section: Discussionmentioning

confidence: 99%

“…Our late acute group incorporated those identified elsewhere as acute hematogenous, since we were unable to identify a primary site of infection in most cases. Their treatment followed our same protocol [ 9 ].…”

Section: Methodsmentioning

confidence: 99%

“…The diagnostic criteria and treatment modalities of acute PJI have been the subject of much debate [ 9 , 10 , 11 , 12 ]. Parvizi et al in 2018 conducted a large retrospective review of THA and TKA cases and validated the evidence based diagnostic criteria [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

“…Debridement, antibiotics and implant retention (DAIR), usually combined with modular component exchange, has been the treatment of choice for acute PJI of the hip. However, the definition of acute PJI has been confusing, variable and subject to much debate [ 9 ]. Early acute PJI implies an onset of acute symptoms varying from 4 weeks to 3 months after index surgery [ 3 , 14 , 15 , 16 , 17 , 18 ].…”

Section: Introductionmentioning

confidence: 99%

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Is Negative Pressure Wound Therapy with Instillation Suitable for the Treatment of Acute Periprosthetic Hip Joint Infection?

Beckmann

Hanslmeier

Omlor

et al. 2021

JCM

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Background: Periprosthetic joint infection (PJI) can be devastating for the patient and demanding for the surgeon. In acute PJI, attempts are made to retain the prosthesis by debridement of the infected tissue, targeted antibiotic therapy and an exchange of modular components with implant retention (DAIR). There has been sparse research with adjunctive negative pressure wound treatment with wound irrigation (NPWTI) on the treatment outcome. Questions/purposes: The goal was to assess the efficacy of our protocol of DAIR with adjunctive NPWTI in acute PJI and to reduce the need for later additional DAIR and Irrigation and Debridement (I and D). Patients and Methods: Our cohort of 30 patients (31 hips) with acute PJI was divided into two groups based on symptom presentation up to 6 weeks or >6 weeks from prior (index) surgery (acute early or acute late groups, respectively). All received DAIR with an exchange of modular components and NPWTI with polyhexanide instillation, with the goal of bacterial elimination and biofilm elimination. Postoperatively, the patients were followed up clinically and radiographically for a mean of 4.3 years. Results: Of the 31 PJI hips, 19 were early acute and 12 were late acute. In total, 21 hips had no evidence of residual infection, 10 required further surgical revision: 1 due to dislocation and 9 due to infection. Of these nine, seven had a removal of all the components and two were treated with irrigation and debridement (I and D), with the demise of one patient from pneumonia shortly after the procedure. The Kaplan–Meier 60-month revision free implant survival from infection was 73.2% (CI: 58.9–91.0%) and at the final follow up, the mean Harris Hip Score (HHS) was 81.1 ± 11.8 and the mean WOMAC score was 33.3 ± 20.1. Conclusions: Our results are in line with those reported in prior studies. However, the utility of our protocol is inconclusive and needs further evaluation based on our small cohort and the lack of a control group. Level of Evidence: IV.

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