Persistent Fistula for Treatment of a Failed Periprosthetic Joint Infection: Relic From the Past or a Viable Salvage Procedure?

Troendlin, Florian; Frieler, Sven; Hanusrichter, Yannik; Yılmaz, Emre; Schildhauer, Thomas A.; Baecker, Hinnerk

doi:10.1016/j.arth.2019.09.012

Cited by 9 publications

(19 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…After all, the most feasible FA for each individual case must be chosen in accordance with the patient, keeping in mind, that CF must be considered with poor QoL as recently published [20]. Our group experienced that better preservation of joint mobility, compared to GRA or arthrodesis, is contradicted by the hygienic situation, demanding regular maintenance measurements.…”

Section: Discussionmentioning

confidence: 95%

The Dark Side of Arthroplasty: Competing Risk Analysis of Failed Hip and Knee Arthroplasty With Periprosthetic Joint Infection

Leitner

Posch

Amerstorfer

et al. 2020

The Journal of Arthroplasty

View full text Add to dashboard Cite

Background: Increasing total hip (THA) and knee (TKA) arthroplasties inevitably lead to accumulating failed arthroplasty (FA) with periprosthetic joint infections (PJI) and definite treatment recommendations are scarce. Our aims were to evaluate patient and infection site specific risk factors, and to identify case-dependent salvage procedure recommendations. Methods: Retrospective analysis was conducted of salvage procedures for FA after PJI (amputation, Girdlestone resection arthroplasty [GRA], arthrodesis, or chronic fistulation [CF]) from 2008 to 2018. Univariable and multivariable modeling of revision and mortality rates, using cumulative incidence competing risk analysis, and Cox proportional hazards models were calculated. Results: In total, 135 patients (THA 62%; TKA 38%) were diagnosed for FA after PJI, having undergone an average of 3 [1-4] revisions at a mean follow-up of 12.8 [7.8-20.9] years. Forty-four percent of THAs and 55% of TKAs had to be revised following FA, 44% deceased during follow-up, and 16% could be reconverted to an infection-free arthroplasty. GRA revealed significantly higher revision rates than CF (P ¼ .015) for THA. Lower age (P ¼ .003), higher number of revisions before FA (P ¼ .007), more than one microorganism at infection site (P ¼ .034), and GRA (P ¼ .037, only THA) prevailed independent risk factors for revision. Patients' age remained an independent mortality risk factor (P ¼ .001). Conclusion: High-risk patients suffering from FA after THA with poor constitution profit from controlled constitution of CF, reducing the risk for revision surgeries and hospitalization. In case of FA after TKA, data did not allow definite treatment recommendations. We believe that education concerning amputation should be considered early after multiple TKA revisions.

show abstract

Section: Discussionmentioning

confidence: 95%

The Dark Side of Arthroplasty: Competing Risk Analysis of Failed Hip and Knee Arthroplasty With Periprosthetic Joint Infection

Leitner

Posch

Amerstorfer

et al. 2020

The Journal of Arthroplasty

View full text Add to dashboard Cite

show abstract

“…59 A supressão antibiótica está indicada como medida de salvamento em pacientes que não têm condições de serem submetidos a novos procedimentos cirúrgicos. 55 A toxicidade do antibiótico, sua disponibilidade oral e a capacidade de supressão da infecção devem ser consideradas para podermos indicar este tipo de tratamento. 55 Conflito de Interesses Os autores declaram não haver conflito de interesses.…”

Section: Medidas De Salvamentounclassified

“…55 A toxicidade do antibiótico, sua disponibilidade oral e a capacidade de supressão da infecção devem ser consideradas para podermos indicar este tipo de tratamento. 55 Conflito de Interesses Os autores declaram não haver conflito de interesses. Dr. Barreto informa que recebeu honorários pessoais da Stryker Latin America, fora do presente trabalho.…”

Section: Medidas De Salvamentounclassified

“…Few amputee patients can adapt to the prosthesis and walk again. 3 55 On the other hand, most patients submitted to arthrodesis have preserved walking capacity. 3 In the study by Mozella et al, 56 44% of the patients submitted to amputation were able to be protetized, only 27.78% were community ambulators and 56% became wheelchair users.…”

Section: Rescue Measuresmentioning

confidence: 99%

See 1 more Smart Citation

Infecção periprotética do joelho – Parte 2: Tratamento

Barretto

Campos

Ooka

2022

Rev Bras Ortop (Sao Paulo)

View full text Add to dashboard Cite

ResumoDiversas modalidades de tratamento são propostas para as infecções periprotéticas, com índices de sucesso variáveis. No entanto, a eficácia está relacionada à seleção adequada dos casos para cada tipo de tratamento.O desbridamento com retenção do implante é indicado em infecções agudas com implante fixo, e seu sucesso depende do tipo de infecção, das comorbidades do hospedeiro e da virulência do agente etiológico.A revisão em um ou dois estágios se impõem nos casos em que haja formação de biofilme, ou nos quais se tenha afrouxamento do implante. A escolha entre realizar a revisão em um ou dois estágios depende de fatores como identificação do agente etiológico, virulência do patógeno, fatores locais e sistêmicos do hospedeiro.Os procedimentos de salvamento como artrodese, amputação, artroplastia de ressecção ou, ainda, supressão antibiótica são reservados para os casos em que não se conseguiu erradicação da infecção.

show abstract

“…Prendki et al konnten nachweisen, dass die Suppression vielversprechende mittelfristige Ergebnisse in der Behandlung persistierender periprothethischer Infektionen zeigt [28]. Troendlin et al belegen, dass die stabile Fistel sehr komplikationsträchtig ist und mit einer maßgeblichen Reduktion der Lebensqualität, nicht zuletzt wegen der Stigmatisierung der Patienten, einhergeht [29]. Die Amputation stellt bei entsprechender Patientenselektion aufgrund weit fortgeschrittener, exoprothetischer Versorgungsmöglichkeiten ein zielführendes Salvage-Verfahren bei persistierenden Infektionen dar.…”

Section: Diskussionunclassified

Does the Implementation of the PRO-IMPLANT Foundation Treatment Algorithm Improve the Outcome of Chronic Periprosthetic Knee Infections? Mid-Term Results of a Prospective Study

et al. 2021

Self Cite

View full text Add to dashboard Cite

Background Several treatment options for chronic periprosthetic joint infections have been published in the current literature, with an on-going discussion to determine effective management algorithms. Objectives To compare outcomes of the two-stage exchange procedure in revision TKA prior to and after implementation of the PRO-IMPLANT Foundation treatment algorithm. The primary endpoints were defined as (i) revisions during the interval time, (ii) duration of the interval time and (iii) successful PJI eradication. Material and Methods Between 02/2013 and 09/2016, 122 patients were included in a single-centre cohort analysis. 55 patients were treated according to the previously used algorithm (K1) and 67 according to the PRO-IMPLANT Foundation algorithm (K2). A minimum follow-up period of 3 years was set as the inclusion criterion. Successful eradication of infection was defined in accordance with the consensus criteria by Diaz-Ledezma et al. Results Successful eradication was achieved in 42 (67%) patients in K1 and 47 (85.5%) in K2 (p ≤ 0.005). The mean interval time was 88 days (range 51 – 353) in K1 and 52 days (range 42 – 126) in K2 (p ≤ 0.005). In K1, a mean of 0.8 (range 0 – 6) revisions were necessary during the interval period compared with 0.5 (range 0 – 4) in K2 (p = 0.066). Conclusion Implementation of the PRO-IMPLANT treatment algorithm led to significant improvement in the outcome of periprosthetic joint infections. During mid-term follow-up, infection eradication was highly successful, with decreases in the interval time as well as the number of revisions.

show abstract

Persistent Fistula for Treatment of a Failed Periprosthetic Joint Infection: Relic From the Past or a Viable Salvage Procedure?

Cited by 9 publications

References 38 publications

The Dark Side of Arthroplasty: Competing Risk Analysis of Failed Hip and Knee Arthroplasty With Periprosthetic Joint Infection

The Dark Side of Arthroplasty: Competing Risk Analysis of Failed Hip and Knee Arthroplasty With Periprosthetic Joint Infection

Infecção periprotética do joelho – Parte 2: Tratamento

Does the Implementation of the PRO-IMPLANT Foundation Treatment Algorithm Improve the Outcome of Chronic Periprosthetic Knee Infections? Mid-Term Results of a Prospective Study

Contact Info

Product

Resources

About