Prosthetic Joint Infection: Report on the One versus Two-stage Exchange EBJIS Survey

Leite, Pedro Santos; Figueiredo, Sérgio; Sousa, Ricardo

doi:10.7150/jbji.14671

Cited by 13 publications

(8 citation statements)

References 12 publications

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“…The indications for single-or two-stage revision of the infected hip arthroplasty also remain an area of developing research, with wide variation in practice. 24 Patient selection is important with consideration of patient factors, the infected joint itself, and the organism profiles. 25 In the earlier patients in this cohort, a definitive plan for a single-or two-stage approach was usually made from the outset.…”

Section: Discussionmentioning

confidence: 99%

Cement-in-cement revision of the femur in infected hip arthroplasty in 89 patients across two centres

Fishley

Selvaratnam

Whitehouse

et al. 2022

The Bone & Joint Journal

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Aims Femoral cement-in-cement revision is a well described technique to reduce morbidity and complications in hip revision surgery. Traditional techniques for septic revision of hip arthroplasty necessitate removal of all bone cement from the femur. In our two centres, we have been using a cement-in-cement technique, leaving the distal femoral bone cement in selected patients for septic hip revision surgery, both for single and the first of two-stage revision procedures. A prerequisite for adoption of this technique is that the surgeon considers the cement mantle to be intimately fixed to bone without an intervening membrane between cement and host bone. We aim to report our experience for this technique. Methods We have analyzed patients undergoing this cement-in-cement technique for femoral revision in infection, and present a consecutive series of 89 patients. Follow-up was undertaken at a mean of 56.5 months (24.0 to 134.7) for the surviving cases. Results Seven patients (7.9%) required further revision for infection. Ten patients died of causes unrelated to their infection before their two-year review (mean 5.9 months; 0.9 to 18.6). One patient was lost to follow-up at five months after surgery, and two patients died of causes unrelated to their hip shortly after their two-year review was due without attending. Of the remaining patients, 69 remained infection-free at final review. Radiological review confirms the mechanical success of the procedure as previously described in aseptic revision, and postoperative Oxford Hip Scores suggest satisfactory functional outcomes. Conclusion In conclusion, we found that retaining a well-fixed femoral cement mantle in the presence of infection and undertaking a cement-in-cement revision was successful in 82 of the patients (92.1%) in our series of 89, both in terms of eradication of infection and component fixation. These results are comparable to other more invasive techniques and offer significant potential benefits to the patient. Cite this article: Bone Joint J 2022;104-B(2):212–220.

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Section: Discussionmentioning

confidence: 99%

Cement-in-cement revision of the femur in infected hip arthroplasty in 89 patients across two centres

Fishley

Selvaratnam

Whitehouse

et al. 2022

The Bone & Joint Journal

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“…This was well-reflected in our own results, as 5 out of 6 patients with type IV complications had recurrent infections. Hence, megaprosthesis implantation in infection-eradicated tissue (after one- or two-stage exchange in patients diagnosed with PJI) [ 37 , 38 ] did not reduce the relative risk for developing PJI and was still notably higher when compared to the relative risk for developing PJI in patients who did not suffer from previous PJI. In descending order of incidence, other complications of megaprostheses detected in our study population were periprosthetic fracture and aseptic loosening.…”

Section: Discussionmentioning

confidence: 99%

Proximal femoral reconstruction with modular megaprostheses in non-oncological patients

Döring

Vertesich

Martelanz

et al. 2021

International Orthopaedics (SICOT)

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Introduction Multiple revision hip arthroplasties and critical trauma might cause severe bone loss that requires proximal femoral replacement (PFR). The aim of this retrospective study was to analyse complication- and revision-free survivals of patients who received modular megaprostheses in an attempt to reconstruct massive non-neoplastic bone defects of the proximal femur. Questions/purposes (1) What were general complication rates and revision-free survivals following PFR? (2) What is the incidence of complication specific survivals? (3) What were risk factors leading to a diminished PFR survival? Materials and methods Twenty-eight patients with sufficient follow-up after receiving a modular proximal femoral megaprosthesis were identified. The indications for PFR included prosthetic joint infection (PJI), periprosthetic fracture, aseptic loosening, non-union and critical femoral fracture. Complications were grouped according to the ISOLS-classification of segmental endoprosthetic failure by Henderson et al. Results Overall, the complication-free survival was 64.3% at one year, 43.2% at five years and 38.4% at ten years, with 16 patients (57%) suffering at least one complication. Complications were dislocation in eight patients (29%), PJI in 6 patients (21%), periprosthetic fracture in five patients (18%), and aseptic loosening in six patients (21%). Prosthesis stem cementation showed a lower risk for revision in a cox proportional hazard model (95% CI 0.04–0.93, HR 0.2, p = 0.04). Conclusion PFR with modular megaprostheses represents a viable last resort treatment with high complication rates for patients with severe proximal femoral bone loss due to failed arthroplasty or critical fractures. In revision arthroplasty settings, PFR cementation should be advocated in cases of impaired bone quality.

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“…The 2-stage exchange strategy is commonly used in the USA and is considered as the gold standard for prosthesis replacement [ 1 , 12 ]. An European survey (EBJIS survey) also found that 2-stage exchange strategy was the most common philosophy regarding treatment of chronic PJI [ 13 ]. However, when prosthesis replacement was clearly indicated for chronic infections in our study, 1-stage exchange strategy was chosen more frequently (without any significant difference between CRIOACs and other centres).…”

Section: Discussionmentioning

confidence: 99%

Management of prosthetic joint infections in France: a national audit to identify key situations requiring innovation and homogenization

et al. 2021

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Background Prosthetic joint infections (PJI) are one of the most serious complication of arthroplasty. The management of PJI needs a multidisciplinary collaboration between orthopaedic surgeon, infectious disease specialist and microbiologist. In France, the management of PJI is organized around reference centres (CRIOACs). Our main objective was to perform an audit through a questionnaire survey based on clinical cases, to evaluate how French physicians manage PJI. Eligible participants were all physicians involved in care of patients presenting a PJI. Physicians could answer individually, or collectively during a multidisciplinary team meeting dedicated to PJI. The survey consisted as three questionnaires organized in a total of six clinical cases. Results Answers from the CRIOACs to the three questionnaires were 92, 77, and 53%. Between 32 and 39% of respondents did not administer antibiotic prophylaxis despite positive S. aureus pre-operative documentation. One-stage exchange strategy was widely preferred in all clinical cases, with no difference between CRIOACs and other centres. Rifampicin was prescribed for S. aureus PJI, in a situation with (90–92%) or without any prosthesis (70%). There was no consensus for the total antibiotic regimen duration, with prescriptions from six to 12 weeks for a majority of respondents. Conclusions Surgical strategy for the management of PJI was homogenous with a preference for a one-stage exchange strategy. Medical management was more heterogenous, which reflects the heterogeneity of those infections and difficulties to perform studies with strong conclusions.

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Prosthetic Joint Infection: Report on the One versus Two-stage Exchange EBJIS Survey

Cited by 13 publications

References 12 publications

Cement-in-cement revision of the femur in infected hip arthroplasty in 89 patients across two centres

Cement-in-cement revision of the femur in infected hip arthroplasty in 89 patients across two centres

Proximal femoral reconstruction with modular megaprostheses in non-oncological patients

Management of prosthetic joint infections in France: a national audit to identify key situations requiring innovation and homogenization

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